Case study on information provided to animal owner about administering veterinary medicines
Published in the December 2014 issue of Vetboard Victoria's newsletter
The following case study provides an opportunity for general reflection. The 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
Blood samples were taken from dogs at an interstate kennel and submitted for testing. On receiving the blood test results, which were determined to be satisfactory, the owner of the kennel requested a second opinion from a veterinary practitioner in Victoria. The Victorian veterinary practitioner, Dr P, advised that the tests indicated the possibility of a viral infection and suggested a treatment plan involving the use of levamisole. A detailed document was faxed to the owner.
The owner commenced treatment of the dogs. A week later, the owner observed that several of the dogs had diarrhoea; and a few days later, the dogs were showing signs of being unwell and having seizures. In the space of a week, six of the dogs treated had either died or been euthanased, having suffered from severe illness and seizures.
After a preliminary investigation, the matter was referred to an informal hearing into the professional conduct of Dr P. It was alleged that Dr P provided veterinary advice to the owners of the dogs involving the use of a medication, levamisole, without the due care and attention expected of a registered veterinary practitioner.
Dr P was found to have engaged in unprofessional conduct and the informal hearing panel determined that Dr P 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 of how their conduct failed to meet the minimum required standard and how that standard might be met in future. The Panel may counsel in any way they see fit. The counselling may be oral, written, given immediately or with 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. In this case the counselling was provided during the hearing procedure.
The informal hearing panel made its findings based upon the following reasons:
The panel considered that the main concerns in this case were the communication and professional advice that Dr P provided.
After reviewing the blood test report that the owner sent to them, Dr P stated to the panel that they suspected the dogs may have been suffering from an immuno-deficient condition / viral infection, and they provided the owner with a treatment plan document used by the veterinary clinic for treatment of such cases.
Dr P advised the panel that the owner was not charged for this advice because the clinic has a special interest in dogs. It is common and accepted practice for the clinic to provide advice to clients, at no charge, with information about the best care and the most appropriate medication for their dogs and to then refer the client back to their current treating veterinary practitioner with this information.
The panel reviewed the treatment protocol given to the owner by Dr P and noted that amongst other things it included the administration of levisamole, to be given to each dog at the rate of "4ml (50mg) twice daily for fourteen days".
The Panel was concerned that levisamole is available in a variety of products containing differing formulations and concentrations of the active ingredient, and that the advice about which form of levisamole or product the owner should have used for the dogs was imprecise.
Dr P informed the panel that they had explained the dosage of the medications listed on the treatment plan to the owner over the phone; however, they had felt that the owner didn’t understand them fully so they faxed a copy of the treatment plan document. Dr P also stated that they had advised the owners that they needed to seek advice from their treating veterinary practitioner about dosage rates and the availability of the medications listed on the plan.
Dr P said that, after the initial conversation, they had received two further phone calls from the owners asking for the actual name of levisamole and its dosage rate. Dr P advised the Panel that on both of these occasions they could not answer the owner’s questions about the product purchased, as the owner could not tell them the concentration levels of the product at the time; and they had therefore advised the client not to use the product and to seek advice from their veterinary practitioner. In their response to the Board, the owner denied that Dr P had advised them to seek other veterinary guidance, and had informed the owner that the products listed in the treatment plan were readily available over the counter.
Despite conflicting information from both parties, the panel agreed that the treatment plan given to the owner contained non-specific and inadequate levels of detail and information regarding the administration of levisamole, considering the potency and potential toxicity of this medication when used “off label”, i.e., not according to manufacturer’s specifications. The panel also noted that no information detailing the possible side effects and complications surrounding this medication had been provided to the owner.
The panel considered that a veterinary practitioner who offered written advice to a client, especially when the advice suggested the use of unregistered products, had a responsibility to ensure that an accurate and thorough explanation of the dosage, administration and potential side-effects was provided to the client.
The informal hearing panel acknowledged that the veterinary clinic had since revised the treatment information sheet for viral infection and has changed the treatment protocol when a recommendation for medication is made. The clinic now only speaks to the treating veterinary practitioner.
Relevant guidelines