A pregnant female dog was presented for elective caesarean surgery. Dr G performed the procedure and delivered seven live puppies.

The dog and her puppies were discharged, but shortly after being taken home the dog became restless and agitated. When the owner contacted the veterinary clinic, they were reassured that this behaviour was normal after a caesarean section.

Four days after surgery, the dog gave birth to two still born puppies.

By the fifth day, five of the seven live puppies had died.

The owner alleged that Dr G was negligent in that he performed a caesarean section without due care and attention, leaving two puppies in utero.

After a preliminary investigation, the matter was referred to an informal hearing into Dr G’s professional conduct.

Dr G advised the informal hearing panel that he thought he had fully palpated the uterus to ensure that there were no more puppies in utero.

On the evidence presented, and by Dr G’s own admission, the panel determined that Dr G had failed to exercise the skill and care expected of a registered veterinary practitioner and that his professional conduct was of a lesser standard than that which might reasonably be expected of a veterinary practitioner by his peers and/or the public.

The panel found that Dr G had engaged in unprofessional conduct within the meaning of the Veterinary Practice Act 1997 and determined that Dr G be counselled.

Counselling is one of the determinations that may be made following a finding of unprofessional conduct. It is a formal process during which the veterinary practitioner is informed how his or her conduct failed to meet the minimum required standard and how that standard might be met in future. Counselling is permanently recorded on a veterinary practitioner’s file and may be referred to in any future hearing or action taken by the Board.

Reasons for findings

• this was the dog’s sixth litter
• the dog had undergone caesarean operations previously
• the dog had never had a problem with her litters, and
• they had opted for a caesarean to make delivery easier for the dog.

When the panel asked Dr G to explain why two puppies were left in-utero. Dr G admitted that he had made a mistake, and he said he had been shocked to learn he had left two puppies in utero.

Dr G said that after removing seven live puppies he thought he had fully palpated the uterus and could not feel any more puppies. He explained that he did not have a lot of experience with reproduction in this specific breed of dog, but he did recall that during the procedure he saw many cysts on both uterine horns, that one horn was starting to tear and that both ovaries were visible.

Dr G explained that he had only recently been employed at the veterinary clinic when he performed this procedure. He said that, unlike in other clinics he had worked at, this clinic’s policies were such that he could not familiarise himself with the case before the surgery or follow up the dog’s condition after the surgery.

Dr G advised the Panel that he had performed many caesarean sections throughout his career including a further 25 operations after this surgery.

While noting Dr G’s submissions, the panel determined, based on the information presented and Dr G’s own admission, that in failing to remove two puppies during the caesarean operation Dr G had failed to exercise the reasonable skill and care expected of a registered veterinary practitioner.

Summary

A female cat was presented to a clinic by her owner because the cat had been in labour for several hours and did not seem to be progressing as well as in her previous 3 pregnancies. After initial examination including ultrasound, Dr Q diagnosed dystocia due to uterine inertia.

Dr Q administered oxytocin and the cat delivered a stillborn kitten 10 minutes afterwards.

A second ultrasound detected normal foetal heartbeats. Following discussion of various options, the client chose to proceed with medical management of the cat at the clinic.

• administered a second oxytocin injection, checked in on the cat periodically, and 40-50 minutes later assisted the cat to deliver a second kitten which required oxygen therapy and active warming on delivery and had a weak suckling reflex
• administered a third oxytocin injection and assisted the cat to deliver 2 healthy and active kittens with good suckling reflex, and
• took a radiograph to confirm there were no other kittens in utero.

Allegations and investigation

The owner alleged that Dr Q’s treatment of the cat was negligent, mishandled, and cruel; that Dr Q did not adequately communicate through the process; and that the first kitten’s death was not anticipated.

The preliminary investigation panel considered that there was no evidence of unprofessional conduct and recommended to the Board that the matter not proceed further. The Board accepted this recommendation.

Reasons for findings

Negligence
The panel found no evidence of negligence. Panel members noted that the cat was seen immediately on being presented to the clinic, tests were performed to assess her condition, she was given oxytocin to assist with the birthing process, and Dr Q monitored her on a regular basis. The panel accepted that this process would have taken some time and considered that the time the owner waited between presentation and the birth of the first kitten was not unreasonable in the circumstances.

The owner expressed concern that the cat’s ‘tummy was saturated’ after delivery of the first kitten. Dr Q stated that alcohol had been used to wet the cat’s coat to obtain a better image quality for the ultrasound. The panel took the view that the use of gel or alcohol in such circumstances was reasonable and an accepted practice.

Inadequate communication
The panel noted the cat had been presented to an emergency 24 hour clinic late at night when, as there are reduced staff on duty, veterinary practitioners may be assessing and treating several patients at the same time.

On Dr Q’s communication with the owner, the panel noted that after the first kitten’s birth Dr Q had updated the owner on the cat’s progress and provided options for care including continued medical management of the cat, admission to hospital for further tests, or return home under observation. The panel noted that the owner opted for continued medical management at the clinic.

The panel was presented with conflicting information on whether caesarean section was offered as a treatment option. The owner said a caesarean was never offered as an option; Dr Q said this option was offered in initial discussions but not later because medical management was producing results.

Mishandling and cruelty
Dr Q had to assist the cat at the birth of each of the remaining 3 kittens because the cat was unable to deliver the kittens on its own. The second kitten, especially, appears to have presented abnormally so required physical manipulation by Dr Q to be delivered.

The owner was concerned that Dr Q had delivered the second, third and fourth kittens with a lot of force, without waiting for contractions, and that the cat was ‘screaming in pain’ during this process.

The panel noted that the cat was suffering from uterine inertia and that effective uterine contractions were absent during labour, which prevented normal birthing progress. In these circumstances the panel thought it reasonable for Dr Q to assist the cat by performing vaginal manipulation to stimulate stronger contractions and prevent the kittens from being stuck in the birthing canal for too long. The panel considered that it was not unexpected for a cat to vocalise in these circumstances, and that the process of dystocia is inherently painful.

The panel understood that the situation may have been distressing for the owner but took the view that Dr Q’s clinical management and actions were undertaken in the best interests of the cat, to assist the birthing process and save the kittens.

Cause of death
The panel acknowledged that the death of the cat’s first kitten must have been unexpected and would have been a traumatic event for the owner.

The panel was unable to ascertain the first kitten’s cause of death but was not presented with any evidence to show that Dr Q’s treatment or care of the cat had contributed to or caused the kitten’s death.