INVESTIGATIONS & RESOLUTIONS
Members of the veterinary profession have a responsibility to uphold standards to ensure the public has access to
safe, quality veterinary care. When those standards are compromised, the College responds. Every veterinarian can
learn from these situations and publishing the details of complaints received and resolved is intended to support
that learning. Learning from peers is best. The example below is taken from an actual complaints’ case and is offered
as a self-reflection tool to improve practice across the province.
LEARNING IN PRACTICE
CASE SUMMARY
The member performed a dental
extraction on a small dog. After the dog
was anesthetized, his teeth were closely
examined, and it was determined the
severity of the dental disease required
that 23 teeth be extracted. The clients
were concerned they were not contacted
prior to the dental extractions.
CASE OUTCOMES
The panel decided the nature of the
allegations involving the member did not
warrant a discipline hearing. The panel
provided the member with advice about
the importance of maintaining complete
medical records. Complete medical
records are essential to the health and
well-being of patients. Comprehensive
medical records facilitate patient care,
allow a subsequent practitioner to
understand the patient’s condition and
the basis for the current treatment, and
satisfy ethical and regulatory obligations
for maintaining records. If veterinary care
is questioned, medical records provide a
clear account of services provided.
The panel advised the member it is
prudent practice to have a physical
examination before proceeding with
a treatment that requires anesthesia,
such as dental extractions. In addition,
the member must ensure appropriate
communication with clients and that
consent forms should reflect services
provided.
In consideration of this complaint, a
panel reviewed the material provided by
the complainant, the veterinarian and
the witnesses. As is standard practice,
the panel considered any previous
proceedings against the member.
CASE CONSIDERATIONS
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College Connection Fall 2019 cvo.org
When deliberating on the case, the panel
noted a consent form was signed by the
client. While dental extractions were listed
on the estimate form, they should have
been included on the consent form.
The dog’s last physical examination was
nine months prior to the procedure. In
the panel’s opinion, it would have been
prudent for the member to perform a
physical exam as much can change
in an animal’s condition in that period.
During an exam, the member could have
explained mulitple extractions would likely
be required due to serious periodontal
disease. As well, the clients’ request for a
phone call prior to extractions would have
been communicated.
The panel acknowledged it can be
difficult to determine dental disease
during an oral exam. Often, it is not
possible to determine the extent of
dental disease until after the patient is
anesthetized and x-rayed. The panel
noted the possibility of serious dental
disease being revealed is common given
the difficulty of performing an oral exam
on awake patients and the fact that dental
x-rays cannot be obtained without a
general anesthetic.
New findings often occur during dental
procedures and it would have been
appropriate for the member to discuss
this with the clients and to document
this discussion in the medical record.
The panel noted it would have been
prudent for the member to attempt to
contact the clients prior to extracting any
teeth, regardless of a request to do so.
The panel acknowledged the member
said he now contacts clients during
dental procedures, when it becomes
evident extractions are required. The
new protocol will be helpful in mitigating
against further misunderstandings.
The clients were concerned that no
diagnostic dental x-rays were taken.
The panel reviewed the consent form
and noted dental cleaning and dental
x-rays were listed, however, dental
extractions were not specified. A review
of the medical record did not reveal
any discussion with the clients about
the possibility of dental extractions. It
appears the clients were not prepared for
the likelihood of extractions.
Regarding x-rays, the panel noted
taking x-rays prior to dental surgery is
not a requirement to meet the minimum
standards of practice in Ontario nor are
veterinary practices required to have
equipment to take dental radiographs.
In the panel’s opinion, however, taking
radiographs before and after extraction
is considered best practice. The majority
of dental disease lies underneath the
gum line. Without the benefit of x-rays,
significant oral disease may be missed.
Dental x-rays are useful to document the
severity of disease prior to extraction,
particularly when questions arise
about whether the tooth should have
been removed. Once a tooth has been
removed, it is prudent to document
the removal of all root fragments by
performing a post-extraction x-ray.
Performing dental x-rays would have
assisted in assessing the condition of
the remaining teeth. The panel reminds
the member to review best practices in
veterinary dentistry.
Because of the panel’s concerns about
the member’s practice, the decision was
made to issue advice. The panel’s advice
is intended for the member’s education
and remains on the member’s permanent
record with the College. Advice from
the Committee is not noted in the Public
Register.