Case study on providing after-care information and following up treatment
Published in the July 2013 issue of Vetboard Victoria's newsletter
The following case studies provide an opportunity for general reflection. Each case study is based on a complaint about an individual set of circumstances at a particular time. As veterinary knowledge and professional and community standards and expectations change over time, readers should not assume that the Vet Board would make the same decision when presented with a similar complaint.
Summary
A dog was presented to a veterinary clinic after ingesting rodenticide. The dog was presented by the owner's parents-in-law, who were caring for him while the owner was on holiday. There was no veterinary practitioner in attendance at the time the dog presented. The veterinary nurse contacted Dr T, who recommended that the dog be induced to vomit with the use of lectric soda crystals. After this was done, the dog was discharged into the care of the owner’s parents-in-law. No further treatment was recommended. Five days after ingestion of the rodenticide, the dog’s condition deteriorated and he was re-presented to the clinic. The dog died despite treatment being instigated. The owner alleges that Dr T was negligent in not ensuring that information about the dog’s condition and instructions for further care were communicated to the carers.
The matter was referred to an informal hearing into the professional conduct of Dr T. It was alleged that:
- Dr T failed to communicate adequately all options for care, including but not limited to options for treatment, referral and ongoing care for the dog.
- Dr T failed to ensure that adequate protocols were established for the follow up care of the dog.
Dr T was found to have engaged in unprofessional conduct and the informal hearing panel determined that Dr T be counselled.
Counselling is one of the determinations that may be made following a finding of unprofessional conduct. It is a formal process within which the veterinary practitioner is informed of how their conduct failed to meet the minimum required standard and how that standard might be met in future. A panel may counsel in any way it sees fit. The counselling may be oral, written, given immediately or given within 28 days of the determination. It becomes a matter of permanent record on the veterinary practitioner’s file and may be referred to in any future hearing or action taken by the Board.
Reasons for panel's finding
After becoming aware that the dog had ingested rodenticide, the dog’s carers phoned a veterinary clinic for advice and were advised to take the dog to the closest veterinary clinic. Here, emesis was induced by a veterinary nurse, after she obtained advice over the phone from Dr T (who was working at another clinic). While acknowledging that the situation required a degree of urgency, the panel questioned why the carers were directed to a clinic which did not have a veterinary practitioner in attendance or why the carers were not directed to attend another clinic for veterinary examination and advice after emesis had been induced. Dr T was unable to provide explanations in response.
Dr T reported to the Panel that they had spoken with the veterinary nurse over the phone and was informed by the nurse that the carers were at the clinic with a dog that had recently ingested rodenticide. Dr T consented to emesis being induced by the nurse, which was done successfully. Dr T stated that they discussed requirements for ongoing care with the nurse, including the need for prothrombin time testing to be performed at day two and four after the initial toxin ingestion. Dr T reported that the nurse repeated the instructions back to them and that the carers were next to the nurse during this call so it was possible that they overheard the instructions being repeated. Dr T conceded that an information sheet on rodenticide toxicity containing requirements for ongoing care was not provided to the carers. The entry in the clinical record made by the nurse documents that the requirements for ongoing care were communicated to the carers. The carers denied this was the case and stated that they were told that as the dog had vomited it was unlikely he would suffer any ill-effects but should be monitored over the following days and that they should seek further veterinary care should he appear lethargic or have pale mucous membranes. A further entry in the clinical record made by Dr T states, 'clearly the information about the blood test did not make it through to the clients'. The dog’s owner also reports that subsequent to the event he spoke with the veterinary nurse over the phone and she admitted that she had forgotten to inform the carers of the requirement for blood testing and neglected to follow-up the case in the days after.
The panel considered it was reasonable for the veterinary nurse to induce emesis after the dog presented at the clinic and after discussing the matter with Dr T. The panel was concerned that Dr T did not offer to discuss the matter directly with the carers so as to ensure that they were adequately informed of the risks of rodenticide toxicity and the requirements for ongoing care. The panel was of the opinion that once Dr T was consulted on the matter, the responsibility for the dog’s care rested with them and they should have sought assurance that the carers were fully informed of the nature of the condition and the requirements for ongoing care. The panel was concerned that this responsibility was delegated to a veterinary nurse, especially since Dr T was on the phone and apparently available to discuss the matter with the carers. The panel was of the opinion that it was not sufficient to assume that the carers had overheard the instructions for ongoing care by listening to a phone call in which they were not participating. The panel was also concerned that protocols were not initiated by Dr T to ensure that the case was appropriately followed up and the carers were reminded of the important requirement for blood testing to monitor the dog’s condition.
The panel was informed by Dr T that protocols have subsequently been put in place to ensure that a similar event does not occur in the future. While the Panel considered this to be a positive step, it did not diminish Dr T's responsibility in this dog’s case.
Relevant guidelines