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. NECROPSY MUST BE OFFERED FOLLOWING UNEXPECTED DEATH BRIEF SUMMARY The client took her newly adopted dog to a clinic for updated vaccinations and a physical examination prior to scheduling a spay. The examination was unremarkable and the spay surgery was booked. Preoperative blood testing was not performed on the dog. The dog appeared healthy just before spay surgery began with normal vital signs. Anesthesia consisted of sedation, induction and maintenance on isoflurane. The medical records did not indicate that any complications occurred during surgery. The member told the client that it had been a difficult surgery. The written submissions indicated there was possibly a medical condition of the uterus present at the time of surgery. Later that same day, the dog was discharged from the hospital but was returned that evening due to bleeding at the incision site. The dog was admitted and exploratory surgery was performed to determine the possible cause of hemorrhage. Although the member remained in the clinic with the patient overnight for monitoring, the dog died early the next morning. Following the dog’s unexpected death, a necropsy was not offered to the client, nor was one performed. REASONING The panel advised the member of concerns due to his failure to offer an independent necropsy following the sudden death of a patient. As well, more consideration should 6 / College Connection have been given to postoperative care including extended hospitalization following a difficult surgery. The client alleged the member should have contacted her when the surgery began and the member realized something was wrong with the dog’s uterus. The submissions reviewed by the panel indicate staff attempted to contact the client during the surgery. The panel agreed that it would not have been in the best interests of the dog to stop the surgery for the member to personally phone and discuss the complications, but to continue quickly and cautiously to complete the operation. Although the member advised the client that it had been a difficult surgery, the dog was discharged that day. The panel agreed the member should have recommended to extend the dog’s hospitalization stay or refer her to another veterinary hospital with 24 hour monitoring of patients. Following the dog’s unexpected death, a necropsy was not offered to the client, nor was one performed to definitely determine the cause of death. Although, the written submissions indicated that there was possibly a medical condition of the uterus present at the time of surgery such as a pyometra or mucometra, this was not confirmed through gross postmortem examination, which may have included histopathology, had it been performed. The College’s regulations state a client should be informed of the availability of a necropsy following an unexpected death. Key Considerations Ontario Regulations 1093 • Professional Misconduct • www.cvo.org/consent Interested members are encouraged to review Ontario Regulations 1093. Practice Standards can be found in Part II of the Regulations and defines the various elements which constitute professional misconduct under the Veterinarians Act. One of the requirements of the legislation is that the client is offered a necropsy from an independent veterinarian in situations where the animal dies unexpectedly or from an anesthetic. The full text of the regulations is provided below: The College’s legislation, Ontario Regulation 1093, Section 17 (1) 23, states that professional misconduct includes the following: “If an animal has died unexpectedly or from an anesthetic, failing to promptly inform the client about the availability of a necropsy through a veterinarian independent of the attending veterinarian but, having provided the information, the attending veterinarian or associate, upon the client’s request, may perform the necropsy”.