LEARNING IN PRACTICE
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 case that went before the Complaints Committee and is offered as a self-reflection tool to improve practice across the province .
UNDERTAKING TO ADDRESS SERIOUS CONCERNS
CASE SUMMARY
A 10-year-old cat was examined at an emergency clinic because he was vomiting and had not defecated in two days . Radiographs indicated an abnormal gas pattern suggesting obstruction and blood tests indicated renal failure with high blood urea nitrogen ( BUN ), creatinine and phosphorus . The cat was given subcutaneous fluids and the client was advised to take the cat to her veterinarian . Cerenia ( maropitant ) was administered for vomiting .
The next day , the member assessed the cat as being dehydrated and provided treatment for renal failure . The cat was hospitalized and placed on intravenous ( IV ) fluids . The member continued the Cerenia treatment and added Famotidine , an antacid and Mirtazapine , an appetite stimulant . A radiograph had normal results but the cat was breathing abnormally . The cat had received excessive fluids and his fluid drip was discontinued . Furosemide , a diuretic , was administered to help clear his lungs . A blood sample indicated a worsening of the renal failure . The member contacted the client to advise her about the cat ’ s grave prognosis and recommended euthanasia , which was performed .
In the complaint , the client alleged the member was negligent in his treatment and care of the cat .
CASE OUTCOMES
The panel decided the nature of the allegations , although serious , did not warrant a discipline hearing . The panel decided remediation was necessary to assist the member in making changes to his practice . The member entered a mutual acknowledgement and undertaking with the College which included assessments of his practice , mentorship , medical records review and completion of learning modules .
CASE CONSIDERATIONS
During the panel ’ s review , concerns were noted on the member ’ s overall management and treatment of the patient . The medical record did not include particulars of an examination . A review of the records indicated they fell below the standards of the profession .
The medical record did not note the heart murmur . If the member had performed a physical examination , he would likely have found this abnormality which would have influenced the cat ’ s prognosis , treatment plan and level of monitoring . A heart murmur , in this case , suggests heart disease . This condition contributed to the cat ’ s inability to manage the sudden increase in blood volume provided by the IV fluids and may have contributed to his morbidity . In the panel ’ s opinion , not performing a physical examination was a serious failure . The panel addressed this issue in the undertaking with a mentorship program on managing feline cardiac / renal patients .
The panel expects hospitalized patients are evaluated regularly and re-evaluated when changes occur . In this case , some monitoring data was recorded but there was no ongoing assessment . Re-evaluation should include a physical evaluation which allows a veterinarian to make changes to the treatment or to confirm the current treatment is appropriate . This did not appear to occur . The undertaking includes education about managing a cardiac and / or renal patient , including assessments to guide fluid treatment , and the requirements to document information in the medical record .
On monitoring patients overnight , the panel was satisfied with the member ’ s changes to the clinic ’ s protocol to obtain client consent to refer patients requiring overnight monitoring to an emergency hospital or , where practical , to send patients home for monitoring .
The panel took into account that furosemide is a “ loop ” ( acts at the loop of Henle ) diuretic and is the most potent type of diuretic . Furosemide is effective and for over 50 years has been the most commonly used drug for treating congestive heart failure .
The member did not indicate discussion with the client about the risks of administering furosemide , nor did he provide appropriate justification for using this diuretic . The panel was concerned with the route of administration of furosemide and also with the lack of intervention once no improvements were achieved . The panel expects the undertaking will help the member learn about the appropriate use of fluid therapy and diuretics in the renal patient and in the cardiac patient as well as the expected outcomes of using furosemide .
In conclusion , the panel noted the College has an opportunity to assist with improving the member ’ s practice with respect to the medical management of cardiac patients with renal disease , as well as improving his communication skills and his medical record keeping . The panel determined significant action was required to meet the College ’ s obligation to protect the public interest and decided that remediation through an Acknowledgment and Undertaking and oral advice was appropriate in this situation . This decision will form part of the member ’ s history and may be considered by the Complaints Committee in the case of any future complaints .
6 College Connection Fall 2020 cvo . org