College Connection Winter 2016 | Page 6

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. MEMBER GIVEN GUIDANCE ON MEDICAL RECORDS, CANINE DYSTOCIA CASE SUMMARY The member examined a pregnant threeyear-old dog who was in labour. The dog had delivered six puppies the previous year. The member tended to the dog through the night and administered three oxytocin injections. He phoned the client in the morning for authorization to take a radiograph and then phoned the client to advise and seek authorization for a caesarian section. The client agreed and asked for the dog to have an ovariohysterectomy at the same time. The dog successfully nursed four puppies, with two puppies having died. The member dispensed antibiotics less than two weeks later for treatment of a complication at the incision site. Two days later, the client brought the dog back for a skin condition which was said to be related to the dog’s allergies. The member advised her to treat with Surolan. The client took the dog to a different hospital where the skin condition was identified as possibly being the result of a thermal burn. In the complaint, the client alleged the member was negligent in the dog’s care and treatment. The client alleged the member failed to offer an immediate C-section; failed to offer a referral to an emergency facility; and failed to keep appropriate medical records. Further, the dog suffered a thermal burn which the member said was a fungal infection or food allergy. CASE CONSIDERATIONS In consideration of this complaint, a panel reviewed the medical records of both clinics, as well as written submissions from the client, the member and his technician. The panel had concerns with the standard of care and noted that it was difficult to make a complete assessment because of the poor quality of the medical records. The management of a canine dystocia case requires attention to physical and 6 / College Connection metabolic complications through diagnostic testing, supportive medical care (IV fluids, analgesia, and treatment of any metabolic derangements such as hypocalcemia, hypoglycemia) and extensive communication with the owner regarding priorities, options and timelines. There was a discrepancy in the recollection of events by the two parties. Th e member indicated the client had initially declined a radiograph. The panel suggested the member ask clients to sign a “declined services” waiver in instances where the medical treatment plan is not accepted. The panel felt that analgesia needs to be considered in cases of complicated labour in a dog, but was not able to confirm the dog suffered while under the member’s care. The panel had concerns with the repeated administration of injectable oxytocin and the dose used – without the specific consent of the owner, or an established plan to proceed with a caesarian section if labour was not productive over a reasonable timeline. The panel agreed the dose of oxytocin in current formularies is in the range of 0.5 to 3 units per dog – with a caveat to ensure calcium and glucose levels are adequate, and the option to go to surgery within hours. Had the dog been suffering from sub-optimum blood calcium or blood glucose levels, oxytocin would not have helped promote delivery. There was no evidence this diagnostic testing was offered or performed. The panel was unable to confirm the death of two of the puppies was due to the member’s management. The area has several clinics designed to accept patients who need urgent care. While the member could be commended for accommodating clients after hours, the panel was not certain his facility was staffed overnight at a level required for undertaking a caesarian section and the immediate after care. The member might have offered a referral to an emergency clinic. The panel has processed several occurrences of suspected thermal burns. The difficulty in confirming the origin of these lesions is the delay in the appearance of clinical signs and the variability of signs that suggest other skin conditions. The panel was not convinced the member intentionally tried to cover up the hair loss and lesions, as he only examined this condition one time in a “drop in” appointment he did not charge for. The member failed to make a medical record for this visit. The panel hopes the member takes extra care in using warming equipment. The panel was unable to evaluate the standard of care due to the lack of comprehensive recording of communication, observation, examination, diagnostic, treatment and surgical events. There was a lack of recording of treatment and observations from when the dog was left at the clinic until she had x-rays. Also, there was no surgical record or reference to a protocol for a standard caesarian or added ovariohysterectomy. CASE OUTCOMES The Complaints Committee panel decided that the nature of the allegations made against the member did not warrant a discipline hearing and therefore directed that this matter not be referred to the Discipline Committee. However, the member was invited and agreed to participate in an undertaking to address the panel’s concerns. Through participation in the undertaking, the member completed a continuing education session on Canine Dystocia. The member’s records were reviewed by a peer reviewer and a medical records workshop was provided for the member and his staff.