college connection
PRACTICE ADVICE
DOES A WAIVER SOLVE DILEMMA OF PATIENT HEALTH RISKS?
A common prescribing and dispensing
dilemma occurs when treating patients with
chronic disease such as diabetes mellitus
or hyperthyroidism. Ongoing assessment
is needed to ensure patients receive the
appropriate treatment while minimizing risk
to their health. However, clients will often
claim that their pet is doing “fine” and do not
want to bring their animal to the clinic for an
examination and/or diagnostics before a refill
of medication is dispensed. They are happy
to sign a “waiver”.
This places a veterinarian in a difficult
position. The patient needs the medication,
however, if you have not assessed your
patient, providing ongoing refills could
potentially result in risk to the patient’s health.
Is the use of a “waiver” the way to solve this
dilemma?
discussion with the client. If an examination
and/or diagnostic test is indicated prior to
medication being prescribed and dispensed,
a client cannot “waive” a veterinarian’s
professional obligation toward their patient.
Discussions with clients in these contexts
is central to decision making. The decision
to dispense a medication rests with
the veterinarian, not with the client. The
veterinarian determines which drugs will be
dispensed, their dosage and their frequency.
The client provides their consent to accept the
veterinarian’s professional advice, based on
the risks explained to them.
Waivers do not protect veterinarians from
liability. “Waivers” give clients a false sense
Veterinarians are to maintain accepted clinical
standards and legislative requirements
when treating their patients. When using
professional judgment about continuing
to dispense medication to a patient with a
chronic condition, the veterinarian should
consider the clinical standards related to that
condition and what a peer would consider
reasonable under the circumstances. If a
veterinarian is concerned that continuing to
dispense medication without examining and/
or performing diagnostic tests on their patient
could result in risk to the patient’s health, he/
she should discuss this with the client.
that they make the decisions about obtaining
medications for their animals and that a waiver
allows a veterinarian to practice outside the
legislative requirements and professional
expectations. Informed client consent
discussions, client education and being clear
as to what your professional obligations are
towards your patients is the route to follow.
What happens if a client continues to request
medication refills but declines assessment
recommendations? A client’s continued non-
adherence to a recommended treatment plan
would be a reason to officially terminate the
veterinarian-client-patient relationship and the
client should be made aware of this.
A veterinarian may refill enough medication
for the patient that allows adequate time
for the client to book an appointment, or to
find another veterinarian if termination of
the VCPR is initiated. This should be clearly
documented in the patient record.
Practice Advisory Service
If you have a question related to the
regulations, policy and expectations
associated with the practice of
veterinary medicine, please contact the
College. The practice advisory service
offered by the College is free and
confidential.
[email protected]
Client education about the disease and
reasons for recommendations for ongoing
assessment are part of the informed consent
www.cvo.org/Practice-Advice
RECENT DISCIPLINE SUMMARIES NOW POSTED
The outcomes of discipline hearings are
public information and are intended to provide
a greater understanding of the veterinary
profession’s accountability to the public.
Summaries are posted on the College website
(www.cvo.org/Discipline-Orders) and findings
are noted on the Public Register. Disciplinary
decisions are available by contacting the
College. Discipline Summaries recently
posted are:
Dr. Shailesh Patel
As a result of the uncontested professional
misconduct hearing on November 15, 2017,
the member’s licence was suspended for six
weeks.
The College investigation found the member,
among other allegations, failed to properly
investigate and assess the full extent of the
injuries that were sustained by a small dog.
As well as serving a suspension, the member
is required to complete the College’s
medical records webinar, complete a five-
day mentorship at an emergency veterinary
medical facility, complete a medical records
review and pay costs to the College of
$3,500.
Read a full summary on this case at:
www.cvo.org/Discipline-Orders
Winter 2017 / 7