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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
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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.