college connection
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 CONSENT , CHANGES TO RECORDS
CASE SUMMARY
A neutered greyhound who had been bitten by another dog was taken to the hospital . After the dog had been evaluated , the member discussed the findings of the examination and a treatment plan with the client . They discussed taking a radiograph of the dog ’ s chest to rule out pneumothorax , performing blood work , as well as sedating the dog to explore the one cm tear in the skin overlying the right side of his chest , prior to suturing the wound closed . The client declined the more extensive work-up and repair , and decided to take the dog home and treat with Clavamox and Metacam that she had on hand .
Shortly after leaving the hospital , the client noticed her dog was salivating profusely , whining , and appeared to have a swollen tongue . The client returned to the hospital , where the member attended to the dog in the client ’ s car . The client inquired about the sedation given to the dog . The member initially said the dog had not been sedated , but upon further discussion , it was reported that an injection of hydromorphone ( an opioid ) had been given . CASE CONSIDERATIONS
In consideration of this complaint , a panel reviewed the material provided .
The panel recognized that in an emergency trauma situation , it is not always possible to obtain informed consent for all treatments administered , including analgesics and sedation . Veterinarians are obligated to alleviate pain and suffering , and in the case of an emergency ( such as a significant trauma ), can use professional judgement in following the necessary steps to do so , without always requiring consultation with the patient ’ s owner .
Although the member indicated that she felt that she was alleviating the dog ’ s pain , the panel was not of the opinion that the
small puncture wound qualified as an acute trauma , requiring emergency treatment . Given the mild-moderate discomfort that the dog was experiencing , the member should have first discussed the treatment plan with the client , and obtained her consent for the administration of hydromorphone . Obtaining informed consent , and allowing owners to make decisions regarding the treatment of their pet is essential , in any non-life threatening situation .
The client indicated she was not informed the dog had been sedated , and that even upon her return , the member continued to deny that any sedation was administered . It was only upon further questioning that the member reported the administration of hydromorphone . The member said this was simply an oversight and miscommunication . She had administered the hydromorphone as a means of analgesia ( pain relief ), rather than as sedation . The committee accepted the member ’ s explanation .
In reviewing the medical record , the panel noted the dog received a 0.05mg / kg dose of hydromorphone , which is half of the widely published dose of 0.1 mg / kg . Although published sources identify potential adverse effects of hydromorphone , such as respiratory depression and bradycardia , the panel was of the opinion that such side effects were highly unlikely to occur at such a low dose . The panel also considered the length of time between the administration of hydromorphone ( which occurred immediately after arrival according to the medical record ), and the client leaving an hour later . Again , multiple published sources identify that the peak effect of hydromorphone occurs approximately 10-30 min post administration . The panel agreed that although it would have been ideal for the client to have been made aware of the injection of hydromorphone , the risk of significant side effects was minimal , given the period of time between
administration and discharge from the hospital , as well as the low dose he received .
The panel noted the discharge summary that was received by the client ’ s primary veterinary hospital did not contain information about examining the dog in the car when the client returned to the clinic . This entry was included in the copy of the medical record obtained by the College . There were also other minor discrepancies noted between the two copies , including a description of the dog as ‘ anxious ’ on initial presentation , as well as concerns regarding thrombocytopenia .
The panel understands that in an emergency environment , medical records may be sent off to the referring veterinarian before the attending veterinarian is aware and has a chance to complete the record . While the member is able to make changes to the medical records , the changes need to be added as an addendum . It is not permitted to record the changes into the medical record as if it were the original comments or observations . 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 advised of the panel ’ s concerns .
The member was advised by the panel of concerns regarding obtaining informed consent prior to proceeding with clinical intervention , as well as entering any changes in the medical record as an addendum , rather than suggesting the changes were part of the original document .
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