Case study on providing animal owner with treatment options initially
Published in the December 2013 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
An owner took their dog to a veterinary clinic with a suspected abscess in the mouth. Dr A examined the dog and diagnosed a papilloma on the left side upper lip. After injecting local anaesthetic into the site, Dr A attempted to remove the papilloma with a scalpel. This was unsuccessful as the dog became distressed during the procedure and was subsequently given a sedative. After waiting for a short time for the sedative to take effect, Dr A attempted to continue to remove the papilloma; however, the dog reacted strongly and as a result the owner instructed Dr A to cease treatment.
The owner alleged that Dr A’s treatment of the dog was negligent, inadequate and cruel. It was also alleged that Dr A did not discuss, at any time, the procedure that Dr A intended to perform on the dog and that Dr A’s behaviour and attitude was abrupt, rude and unprofessional.
After a preliminary investigation, the matter was referred to an informal hearing into the professional conduct of Dr A. It was alleged that:
- Dr A’s clinical management and treatment of the dog was inadequate and less than the minimum standard expected of a veterinary practitioner.
- Dr A failed to inform the owner of the treatment options available and did not obtain informed consent for the procedure performed on the dog.
- Dr A’s behaviour and attitude was less than the minimum standard expected of a registered veterinary practitioner by the public and/or his/her peers.
Dr A was found to have engaged in unprofessional conduct and the informal hearing panel determined that Dr A be cautioned.
A caution is a formal notification, in the context of an advisory warning, to a registered veterinary practitioner. It warns the registered veterinary practitioner that a change in their manner of practice is required to conform to the minimum standards of the profession as legislated in the
Veterinary Practice Act 1997 and ancillary legislation (for example, the
Drugs, Poisons and Controlled Substances Act 1981); described in the Board’s written Guidelines; and understood by community standards and those of the veterinary practitioner's peers. A caution is permanently recorded on the veterinary practitioner's file and may be referred to in any future hearing or action taken that the Board may take.
Reasons for the panel's findings
The informal hearing panel reviewed all of the information provided to it, including statements from Dr A and the owner, and made its finding and determination based upon the following reasons:
The owner presented the dog to Dr A’s clinic for a lesion on its lip, which the owner was concerned about. The panel accepted the series of events that followed, which were generally agreed on by the owner and Dr A. The dog was examined and Dr A diagnosed a papilloma on the left upper side lip. Dr A fitted a muzzle to the dog and proceeded to inject local anaesthetic into the base of the papilloma. While Dr A was performing this procedure, the dog became distressed and fought to free itself. The owner states that during this struggle the syringe became loose and ended up embedding itself in Dr A’s leg, who knocked the syringe out of their leg. The syringe fell onto the floor whereupon Dr A picked it up and continued to inject the remaining contents into the papilloma site on the dog’s lip. Dr A informed the panel that this incident ‘may have happened’; however, they could not recall it.
Due to the dog’s distress and at the request of the owner, Dr A gave the dog a sedative. A short time later, Dr A again attempted to remove the papilloma. The dog continued to react vigorously and at the request of the owner Dr A stopped treatment. Dr A stated to the panel that they had managed to remove approximately 80% of the papilloma before ceasing treatment.
The panel was concerned about several aspects of this case.
The panel accepted Dr A’s diagnosis of a papilloma and considered the following explanations and admissions from Dr A in relation to the treatment of the dog: ‘I was thinking about the travel time as the owner lives away from the area so I decided to remove it then and there’; ‘I didn’t tell them what I was going to do’; ‘I would normally inform my clients of the options available and my intentions of treatment; however, I was on my own on that day’; ‘in retrospect I should have sent them home and rescheduled the procedure for another day’; and ‘I should have stopped sooner but I only had a little bit left to remove'.
The panel acknowledged that Dr A had good intentions in taking into account the distance travelled by the owner for the consultation and that Dr A had tried to perform the procedure that day so the owner did not have to travel back to the clinic. However, the Panel reiterated to Dr A the importance and obligation of the veterinary practitioner to provide an explanation of all treatment options available to the client and not to perform a procedure without first obtaining consent. The panel also expressed concern about the allegation that a needle had been used on the dog after becoming embedded in Dr A’s leg and dropping on the floor. Despite Dr A not being able to recall this incident, the panel determined that it had probably occurred and was not acceptable practice by a veterinary practitioner.
The panel also expressed concern about the lack of detail contained in Dr A’s clinical notes. The panel emphasised that, while it is not inappropriate for clinical records to be handwritten on cards, notes must be legible and comprise a complete record of the consultation and discussion between an animal’s owner and the veterinary practitioner. The panel reiterated to Dr A that the clinical record should provide as much information as possible about the animal and its treatment. The panel also emphasised that communication with the client is especially important, particularly when difficulties are experienced, and such problems should always be noted in the clinical record.
Dr A conceded to the panel that they did not manage the circumstances of this case as well as they should have done. In retrospect, Dr A acknowledged that they should have: provided the owner with options for treatment; rescheduled the removal of the papilloma for another day; and discontinued the procedure when the dog became agitated. The panel understood that this would have been a stressful and difficult time for the owner.
With the information presented, the panel determined that Dr A had engaged in unprofessional conduct not of a serious nature.
Relevant guidelines