College Connection Summer 2018 | Page 6

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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 complaints case and is offered as a self-reflection tool to improve practice across the province .
VETERINARIANS NEED TO PRESENT ALL OPTIONS TO CLIENTS
CASE SUMMARY
A member examined a horse that was lethargic and not eating or drinking normally . The member determined the horse was showing symptoms consistent with mild colic . Three days later , the member examined the horse again as his symptoms had not improved . Blood was taken and the sample was submitted for analysis . The member recommended dental treatment . The bloodwork results did not reveal any major organ dysfunction , however , there was an elevation in Serum Amyloid A , a blood chemistry measurement which may be elevated in inflammatory or infectious conditions .
Several days later , the horse received dental treatment but his condition continued to deteriorate . Three days later , the client tried to contact the member with concerns about the horse ’ s symptoms and was unable to reach him . A second veterinarian was contacted and examined the horse that day . The horse was referred to a referral hospital where an abdominal mass was discovered . Due to the poor prognosis and concern for the quality of his life , the horse was humanely euthanized .
The client submitted a complaint alleging the member was negligent when he failed to be alarmed with the high Serum Amyloid A value noted in the blood results and he behaved in an unprofessional manner when he accidentally brought the wrong cell phone with him and could not be reached to provide emergency care for the horse .
CASE OUTCOMES
The panel decided the nature of the allegations involving the member did not warrant a discipline hearing .
However the member is advised of the panel ’ s concerns with his medical records . Medical records must be complete , document client communications and outline differential
diagnoses and treatment plans . As well , the panel had concerns with the member ’ s failure to ensure his client had access to emergency veterinary services .
The member is cautioned that he is required to offer treatment and diagnostic options without prejudice with respect to his client ’ s financial situation and that all abnormal laboratory results , such as Serum Amyloid A , must be taken into consideration with regard to his diagnostic and treatment plans . The member is advised to revise his practice standard protocols and medical records to ensure that the standards of the practice of veterinary medicine are met .
CASE CONSIDERATIONS
In consideration of this complaint , a panel reviewed the material provided . As is standard practice for investigations , the panel considered previous proceedings against the member .
In this complaint , the client alleged the member was negligent when he failed to be alarmed with the high Serum Amyloid A value in the blood results and the treatment provided caused the horse ’ s condition to rapidly deteriorate and he had to be euthanized .
The panel reviewed the medical records and written submissions from all parties involved . Serum Amyloid A is a biochemical marker present in equine blood that may indicate inflammatory or infectious processes . Elevated values of Serum Amyloid A cannot be used alone to diagnose specific diseases in horses , it can only raise suspicion that inflammation or infection is present .
In his written response , the member said he informed the client of the high Serum Amyloid A value . There was no record of the conversation documented in the medical record . The medical record also did not contain a list of potential differential diagnoses for the horse ’ s symptoms or the
high Serum Amyloid A value and there was no plan proposed for treatment other than a recommendation for a float . As well , there was no recommendation for further workup or referral to an equine specialist . The panel felt the member ’ s medical records were deficient and not consistent with the standards expected .
The panel was unable to determine if the member advised the client of the seriousness of the elevated Serum Amyloid A levels given the scarcity of the medical records . The panel reminds the member to consider all deviations in laboratory test results and to act accordingly in order to attempt to establish the cause of the abnormality .
In his written submission , the member said he had contemplated transferring the horse ’ s care to a specialty or referral clinic but decided against it because he perceived the client was having financial difficulties . It is an expectation for veterinarians that all possible diagnostics and treatments are offered to clients without predetermining what the client can and cannot afford . It is up to the veterinarian to offer patients the best care possible , which may include referral to a specialty practice and it is up to the client to decide on the course of action to take .
With regard to the allegation the member behaved in an unprofessional manner when he accidentally brought the wrong cell phone with him , it is an expectation that veterinarians will provide emergency medical coverage for their own regular patients / clients .
In this case , the member was not available to attend to emergencies on the day in question and did not provide the clients with an alternative contact number . The College expects a member to ensure he / she is either available to clients for emergency situations or that he / she provides clients with the contact information for another veterinarian who is available to cover for him / her .
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