Case study on providing veterinary medical records (x-rays) to animal owner, professional peers and Board
Published in the June 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
A dog was presented to a veterinary clinic with ongoing hip and stifle issues.
Dr R examined the dog and x-rays were subsequently taken and reported to show degenerative joint disease and hip dysplasia. On arrival at the clinic to collect the dog, the owner asked to see the x-rays. However, Dr R stated they had been filed and were not available at that time. Over the following weeks the owner attended the clinic and also spoke to Dr R on the phone about the dog’s condition in the expectation they could view the x-rays; however, they were never presented. The owner then took the dog to another veterinary clinic for a second opinion. Requests made for Dr R to forward the x-rays to the second veterinary practitioner were declined. During the Board’s investigation, three requests were made to Dr R before the x-rays were forwarded to the investigation panel.
The owner submitted a complaint to the Board alleging that Dr R: (1) failed to provide services by not allowing them to view the x-rays taken of the dog; (2) refused to forward the x-rays on to the second veterinary practitioner when requested to do so; and (3) was uncaring and disappointing in behaviour and attitude.
After a preliminary investigation, the matter was referred to an informal hearing into the professional conduct of Dr R. It was alleged that:
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Dr R failed to provide services of an acceptable professional standard in regards to the quality of the x-rays taken of the dog.
- Dr R failed to comply with the professional obligation to forward the dog’s x-rays when requested to do so by the second veterinary practitioner (with owner consent).
- Dr R’s behaviour and attitude in relation to the forwarding of the dog’s x-rays to the Board, as part of the investigation, was unprofessional and not of a standard expected by their peers.
Dr R was found to have engaged in unprofessional conduct, and the informal hearing panel determined that Dr R 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 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.
Reasons for the panel's findings
The informal hearing panel made its findings based upon the following reasons.
Allegation 1: Dr R failed to provide services of an acceptable professional standard in regards to the quality of the x-rays taken of the dog.
Dr R took x-rays of the dog’s hips and left stifle, and diagnosed that the dog was suffering from degenerative joint disease and bi-lateral hip dysplasia. Dr R informed the panel that, when the owner returned to the clinic later that day to collect the dog, they were unable to show the owner the dog’s x-rays as they had already been filed. Dr R stated that instead of showing the x-rays to the owner, they explained to the owner 'what was meant by hip dysplasia, femoral head
flattening and degenerative changes, by showing them normal versus abnormal x-rays of another dog'. Dr R stated that the owner seemed happy enough with this at the time.
The panel viewed the x-rays Dr R had taken of the dog and questioned Dr R about their extremely poor quality. Dr R informed the panel that on the day the x-rays were taken they had not realised that the developer was expiring, which had affected the quality of the x-rays. Dr R further informed the panel that as the dog had already been placed under a general anaesthetic once that day, they felt there was enough detail in the x-rays to make a diagnosis of degenerative joint disease and hip dysplasia and didn't think it was warranted to re-anaesthetise the dog to obtain better quality x-rays. Dr R also provided the panel members with recent x-rays they had taken as evidence of the normal quality of the x-rays they produce.
Dr R stated that the owner visited the clinic on two more occasions and never asked to view the x-rays at those times. The owner advised the panel that they could not recall whether they had asked Dr R to see the x-rays on these visits and that they very much doubted their existence due to the fact that they had not been produced when first requested at the initial consultation or when
requested by the second treating veterinary practitioner.
Dr R informed the panel that at the start of the investigation by the Board, they were provided with advice on how to deal with the investigation process, which they followed. Dr R stated that in hindsight this advice may have been incorrect The panel advised Dr R that of the three x-rays taken of the dog, only one of those x-rays was of an acceptable diagnostic standard. The panel understood Dr R’s reluctance to show the owner the x-rays due to their poor quality; however, the owner had paid for a service that was not provided to an acceptable, appropriate and professional standard as would be expected of a registered veterinary practitioner.
Allegation 2: Dr R failed to comply with the professional obligation to forward the dog’s x-rays when requested to do so by the second veterinary practitioner (with owner consent).
The owner took the dog to another veterinary practitioner for a second opinion. The panel was provided with clinical notes from this practitioner which detailed that they had rung and asked Dr R if the owner could come in to collect the dog’s x-rays but that this request was refused by Dr R. An email was sent by the second treating practitioner to Dr R asking for the x-rays to be forwarded but no response was received. A veterinary nurse also rang Dr R's clinic to ask for the dog’s x-rays, but the request was again refused with no reason given.
Dr R informed the panel that they did not receive and were unaware of the email or phone request from the second veterinary clinic, and had only spoken over the phone to the second treating practitioner on one occasion, when they detailed their observations and diagnosis of the dog. Dr R denied having received any other requests for the x-rays from the clinic and stated that they forwarded all other patient notes when requested.
The panel could not account for the conflicting recollections of the parties. Without corroborating evidence to support either party, the panel was unable to substantiate the allegation of unprofessional conduct.
Allegation 3: Dr R’s behaviour and attitude in relation to the forwarding of the dog’s x-rays to the Board, as part of the investigation, was unprofessional and not of a standard expected by their peers.
The panel was concerned that, as part of the investigation process, three requests had to be made by the Board to Dr R to forward the dog’s x-rays. Dr R initially refused to comply until subsequently forwarding the x-rays after the Board's third request.
Dr R informed the panel that, at the start of the investigation by the Board, they had been provided with advice on how to deal with the investigation process which they followed. Dr R stated that in hindsight this advice may have been incorrect and was partly responsible for the decision not to send the x-rays to the Board initially. Dr R also pointed out to the panel that they felt they were under no obligation to forward the x-rays as the letter from the Board only ‘asked for their co-operation’ in sending them and did not demand them. Dr R stated that they were uncertain of their obligations at the time and that they considered they were not under a professional obligation to adhere to the guidelines.
The panel reminded Dr R of their professional obligations as a registered veterinary practitioner; in particular, that although the instruction from the Board was "polite", such courteous correspondence did not diminish their responsibility to comply with those obligations. The Panel considered that Dr R had been obstructive in the course of the investigation, did not follow the request of the Board, and was therefore guilty of unprofessional conduct in this regard.
Relevant guidelines