College Connection | Summer 2024
Panel provides guidance on pain management
College Connection | Summer 2024
LEARNING IN PRACTICE
Panel provides guidance on pain management
Case Summary
The member evaluated a cat for trouble eating and identified significant dental disease . The veterinarian performed dental procedures on the cat as well as excising a mass on its thigh . After the cat was anesthetized , the member had noted the dental concerns were beyond their expertise . The member descaled diseased teeth but did not remove fractured teeth . The cat was discharged with oral antibiotics but no pain medication .
The cat did not do well following these procedures and was seen at another hospital . The cat responded reasonably well to treatment for about a month . Due to the cat ’ s age , risk of non-healing oral condition , and cost of treatment , the cat was euthanized .
A complaint was submitted by a third party .
Case Outcomes
The Complaints Committee panel decided the allegations did not warrant a referral to the Discipline Committee . The panel advised the member of the importance of postsurgical pain management . The College ’ s Position Statement , Pain Management in Veterinary Medicine , articulates the College ’ s expectations for veterinarians to prevent and alleviate animal pain and suffering . Pain management is one of the pillars of veterinary medicine .
Case Considerations
In considering the complaint , the Complaints Committee panel reviewed medical records and written submissions . As is standard for all investigations , the panel considered previous proceedings , if any .
The member indicated the client refused a referral for dental radiographs and a full dental workup . The member felt it was better to try to help the cat than leave him with no treatment . The member indicated they exercised their best professional judgment by proceeding .
The member was not able to perform a detailed oral examination , but foul breath , gingivitis and bad teeth were observed . Also , a slow growing mass on the cat ’ s thigh was documented . The cat was started on Clavamox ( antibiotic ) and scheduled for a dental procedure and mass removal .
The panel noted the preoperative bloodwork showed mild / insignificant amylase elevation , but otherwise was normal . The mass removal was uneventful and the dental was performed with concerns noted indicating the cat would benefit from full mouth extraction .
The cat received a meloxicam injection during the procedure and was discharged with antibiotics / Clavamox . No pain medication or NSAID were dispensed . Discharge instructions stated the cat ’ s mouth may be sore and to feed soft food . There was a reference to Clavamox .
The panel was concerned the member did not dispense pain medication . The dental procedure would have caused significant pain and discomfort . The panel stressed the importance of proper analgesia , particularly post surgically .
In the panel ’ s opinion , the member ’ s advice for treatment was appropriate . The member recommended referral for dental treatment but the client declined . The panel noted that full mouth extraction was the optimal treatment , and informed client consent was provided directing the member to proceed with what could be done .
The panel noted the member attempted to assist the cat ’ s significant oral discomfort by performing dental work , however , the cat ’ s condition deteriorated post treatment . The panel acknowledged the client was profoundly affected by the cat ’ s passing .
The panel had concerns about the lack of appropriate analgesia in this case . As a result of the complaint , the College assisted the member to improve their practice by issuing advice about pain medication so the member can make changes to her practice and avoid a similar concern in the future .
Veterinarians have a responsibility to provide safe , quality care . The College assists veterinarians in doing so when matters are reviewed by the Complaints Committee . The public has a right to ask questions about the care that was provided to their animal ( s ) and this process provides veterinarians with feedback on whether they have met the standards of practice or whether there are improvements needed to mitigate risks in practice . The Committee provides advice or may request a veterinarian enter into an undertaking when remediation would reduce risks and support a veterinarian in meeting the standard of practice . Only the most serious cases , where there is bad intent , incompetence , reckless behaviour , or a history of failure to remediate at-risk behaviour are referred to the Discipline Committee for a discipline hearing to determine if an act of professional misconduct or serious neglect may have occurred . This example is taken from a case that was reviewed by the Complaints Committee and is offered as a self-reflection tool to support veterinarians in understanding how to meet the standards of practice .
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