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 complaints case and is offered as a self-reflection tool to improve practice across the province.
PANEL TAKES NO ACTION AFTER CONSIDERING ISSUES
CASE SUMMARY
The member examined a dog that had been
drinking a great deal of water. The member
noted the dog had a history of dilute urine,
skin allergies and multiple skin cysts. On
physical examination, the member noted a
moderate amount of tartar and gingivitis,
moist skin with redness and crusty scabbing
around the corners of the mouth, and multiple
sebaceous cysts on the chest and back.
The member considered differential
diagnoses of food or environmental allergies,
as well as bacterial infection. Also considered
was the possibility of kidney disease or
Cushings disease due to the increased
drinking and dilute urine. The member
recommended postponing vaccines until the
medical issues were addressed but the client
insisted on a rabies vaccine. Apoquel and
Cephalexin were prescribed and bloodwork
was performed. Further diagnostic testing
including an abdominal ultrasound and
allergy testing were discussed.
A couple days later the member contacted
the client with bloodwork results and reported
a decreased albumin and BUN. The member
also noted the dog’s previous records
indicated the presence of bilirubin in his
urine. The member recommended bile acid
testing to evaluate liver function as well as
an abdominal ultrasound. The client asked to
meet to discuss the results, and the member
asked him to bring a urine sample from the
dog.
The next day, the member met with the client
and the recommendations were reiterated.
The client agreed to bring in a urine sample,
however, this was never obtained. The client
subsequently sought veterinary care for the
dog at another clinic.
The client complained to the College that the
6
/
College Connection
member failed to provide appropriate care to
the dog.
CASE OUTCOMES
The panel decided the nature of the
allegations involving the member did not
warrant a discipline hearing. The panel
decided not to take any further action.
In consideration of this complaint, a panel
reviewed the material provided by the
complainant, the veterinarian and the
witnesses. As is standard practice for
investigations, the panel considered any
previous proceedings against the member.
CASE CONSIDERATIONS
The member stated she tried to provide the
dog with the best care possible and took a full
detailed history, completed a comprehensive
physical examination, reviewed the dog’s
history from the previous clinic, discussed
the differential diagnoses with the client,
and completed diagnostic testing including
bloodwork and recommended a urinalysis.
The client was sent home with a urine
container to collect a free flow urine sample
and also recommended an abdominal
ultrasound to rule out liver disease. The
member consulted with an internist to ensure
the best health care possible was provided.
The client stated the dog’s new veterinarian
prescribed the correct treatment and the dog
recovered in 10 days.
The panel reviewed the medical record which
indicated a focus in determining the potential
cause of the dog’s polydypsia. In the panel’s
opinion, it was appropriate to pursue this
issue. The member presented the client with
possible rule outs, as documented in the
medical record, including kidney disease
and Cushing disease. The bloodwork results
revealed low albumin, BUN and glucose, all
of which could be indicative of liver disease.
In the panel’s opinion, the member’s
recommendation of pre and post bile
acid testing was appropriate as was the
recommendation of a possible ultrasound
and a recheck of the dog’s urine. The results
of these diagnostic tests would have assisted
in arriving at a more definitive diagnosis.
With regard to vaccinations, the member
acknowledged the client wished to have the
dog vaccinated for distemper. The member
explained that vaccinations should be
given after ruling out any serious underlying
medical issues. The member stated she
reluctantly administered a rabies vaccination
at the client’s request but postponed the
distemper vaccine pending blood and urine
results. In the panel’s opinion, this was an
appropriate decision. The panel noted it
would have been prudent to postpone all
the vaccinations, but because rabies is a
zoonotic disease, there appeared to be some
justification for administering it.
The member informed the client in person
and in a follow-up phone call that he should
bring the dog’s urine sample to the clinic
to check the bilirubin level and the specific
gravity of the urine. The client did not reply to
the messages and did not bring in the dog’s
urine sample.
The medical record documented two client
communications by telephone but no details
of what was conveyed were included. The
panel expects the member to ensure that
the content of all client communications is
recorded in the medical record.
In the panel’s opinion, there did not appear
to be sufficient evidence to support the
client’s concern the member failed to provide
appropriate care to the dog.