college connection
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. The example below is taken from an actual case and is offered as a self-reflection tool to improve practice across the province.
PANEL’ S FINDING INDICATES EXCESSIVE FEES CHARGED
CASE SUMMARY
A member at an emergency clinic examined a cat and found it had a heart murmur, was panting and would fall over when walking. The working diagnoses was a brain lesion, or an underlying infection or a thromboembolic event. The clients consented to blood work and radiographs and the cat was admitted. Blood work revealed a mild thrombocytopenia( low platelets) which was not supported by clumped platelets as often happens with cats. Radiographs revealed a dilated stomach, most likely due to aerophagia( swallowing air), as well as an incidental finding of cholelithiasis( gall stones). The next day, the cat had improved significantly. There was no audible murmur, his respiration had returned to normal and he was not showing overt neurologic signs. Initially, the cat was started on butorphanol for pain and sedation but was switched to buprenorphine as well as an anticoagulant( clopidogrel). The cat was transferred to his regular veterinarian and subsequently transferred to an emergency and referral hospital to see a neurologist. Following this, the client sent an email to the clinic with questions regarding medication and charges.
The client submitted a complaint alleging the member prescribed a medication without first confirming a diagnosis; the clinic failed to forward the medical records to the regular veterinarian in a timely manner; the fees charged for an overnight stay were exorbitant; and the hospital director failed to explain the fees.
CASE OUTCOMES
The panel decided the nature of the allegations involving the member who examined the cat did not warrant a discipline hearing. However the member was advised of the panel’ s concerns with regard to charging
a fee that is excessive in relation to the services performed.
Further, the panel decided the nature of the allegations involving the hospital director did not warrant a discipline hearing. However the hospital director was advised of the panel’ s concerns with regard to ensuring his medical records are clear and detailed and include an adequate history, rationale for all assessments and treatments performed, and documentation of conversations with clients. CASE CONSIDERATIONS
In consideration of this complaint, a panel reviewed the material provided. As is standard practice for investigations, the panel considered previous proceedings against the member.
In this complaint, the client alleged the member prescribed a medication without first confirming a diagnosis. The panel agreed there are times when a final diagnosis has not been identified and medication may be started, especially if there is minimal negative impact from the drug. Clopidogrel is a medication used for prophylactic treatment against a blood clot that plugs a vessel and is used frequently in heart disease, particularly in cats. In healthy cats, there are no reported adverse clinical effects and in cats with potential blood clots, there are many benefits. In reviewing the medical record, cardiac disease, including a thromboembolic event, would have been reasonable as a differential.
What confused the panel was clopidogrel was started 36 hours into treatment and 12 hours before discharge although clinical signs had abated. There should have also been a discharge summary in the medical record.
With regard to the allegation concerning the transfer of medical records, the panel did not have any concerns as the records were transferred the day of the discharge. The
College standard says records should be transferred within two business days.
In relation to the concerns about the fees charged, the panel is not empowered to award monies or require a member to reimburse all or a portion of the fees paid. However, the panel does consider whether a fee charged is excessive in relation to the services performed.
The Ontario Veterinary Medical Association and the Canadian Veterinary Medical Association publish a suggested fee guide for Ontario veterinarians. The panel reviewed the 2017 suggested fee guide and noted that fees may be based on many things including, but not limited to, the cost of living, overhead costs of running a small business, the diversity of the services, the equipment available and the type of services being provided. The panel agreed the fees charged by the clinic were excessive in relation to the guide.
Further the panel considered the allegation the hospital director failed to follow up with the client to explain the fees charged.
The panel reviewed the medical record and the last documented notes concerned discrepancies between the two invoices and the client’ s concern medications were started without a diagnosis.
The hospital director asked the client for a copy of the medical records from her veterinarian and the referral hospital with an explanation as to why the medication should not have been started as well as a copy of the referral hospital’ s invoice for comparison. The client claimed she sent the invoices but the panel could not find the documentation. The panel believed the hospital director did make an attempt to address the client’ s concerns and was within his right to request documentation.
6 / College Connection