When Law and Veterinary Medicine Intersect
We’ve all heard loads of scary stories from our cousins on the human medical side of the fence but few vets have yet to gain firsthand knowledge of the deposition table drama that comes with a malpractice lawsuit.
And thank God for that! Or maybe not … depends how you see it, 'cause maybe it’s different on the client side of the fence? (I’m sure you’ll tell me in your comments.)
I have a vet colleague currently experiencing a major legal drama after the death of a dog. And while the circumstances surrounding the situation are common enough — an angry owner looking for retribution after a terrible loss, pitted against a professional defending (in this case) her impeccably high-quality standards — the ensuing battle is not. She’s stressed out over the legal expense, the time lost from work, the personal insinuations and the emotional hardship of reliving the client’s anger and loss with each interaction.
Even if a practitioner did no wrong, the legal process can be endless. Just ask any obstetrician you know. I don’t know one who hasn’t been sued more than once. And why? Because they have a job where life, death, strong emotion, and the vagaries of chance hang in a delicate balance. And that’s the precarious position veterinarians are in, too.
But we vets are not used to being hauled in front of lawyers and judges to defend the way we do our jobs — not yet, anyway. Increasingly, though, we’re forced to practice medicine as if we might be in that position with each and every case.
In some ways that’s good. It makes us careful in our record-keeping, more willing to consider diagnostics before treatment, and conscientiously detailed when securing consent from our clients. In other ways, it’s kind of depressing.
And that’s because we have to practice more defensively. This finds us thinking about clients in an different way, adhering to hard-and-fast protocols with less regard to our patients’ needs, and generally driving the cost of pet healthcare through the roof. (Not to mention the serious stress that brings and the disillusionment with our jobs that can develop when anything gets "legal.")
I was thinking about this because today I read a little bulletin I get about every three months or so. It details the individual legal cases presided over by our most popular malpractice insurance carrier. Vets in legal hot water (and their stories) get listed here as both cautionary tales and (perhaps unwittingly) salacious industry gossip.
I imagine it serves as much for voyeuristic horror-story entertainment as it does to teach us how we could have handled these real-life situations better. The cynical me says the bulletin is less of a service for vets than it is a self-serving tool for the insurance industry; I’m sure it more than pays for itself in reduced claims (by virtue of the paranoia it induces among vets like me).
The stories are frightening:
Vet A’s client loses a fingertip to the jaws of his own pooch (while in the vet hospital) and sues for oodles in lost work-time, medical bills and the emotional hardship of having lost a finger. Presumably, the tech was not able to secure the dog properly or the muzzle was too loose or some other such craziness. (And now you know why I won’t let owners hold their own pets or get near a pet’s mouth during the exam.) The insurance company was out about $17,000 or so after that fiasco.
Vet B’s client got euthanasia solution in her eye (when the syringe malfunctioned and solution sprayed all over the room) and sued for the medical treatment she subsequently received and the potential (currently unknown) horrors that might befall her as a result. I think they actually settled for about two grand (though I can’t tell you how many times I’ve had that stuff in my eyes and mouth and never batted an eyelash over it).
Vet C’s surgical case chewed out its abdominal stitches at home and died after chomping on his own intestines for a while. This happens — rarely — but dogs are not exactly savvy about handling their own maladies and misfortunes. In question: Did the vet send home an E-collar? (Probably.) Were the sutures not "tied" properly? (How can you tell now?) Was the possibility of a dog’s making a meal of his innards ever explained to the (justifiably horrified) owner? (As if any vet could ever run through every known or unknown disaster scenario in exact detail.)
Vet D’s client sued after the geriatric cat he was treating for severe arthritic pain went into renal failure, potentially because he received a three-dose regimen of Metacam. Was the Metacam the cause? Was it normal degeneration? It doesn’t even matter.
The vet lost because he hadn’t explained that the Metacam, given orally, was not approved for use in cats — though most drugs we give cats are not approved for them and though most vets use Metacam in this way. It leaves me wondering … do I mention the labeling issue to every client? Do I send home a package insert on my every Rimadyl case? I usually do, but sometimes I’m so busy, will I be next?
At some point, common sense should dictate more than law. But there are plenty of precedents out there that defy reason. So every vet needs to be extra careful about everything they say and do. For better or worse.
Sure, I see your side of the coin, too: There are gaggles of low quality providers out there in serious need of a lawsuit or, better yet, a license yanking. But so far, most cases tend to be reserved for big-money clients who can afford to sue in spite of low payouts. In turn, they tend to be suing their big-money vets who are more likely to employ more careful policies and procedures. An odd catch-22. But I guess this is how it started in the human medical profession, too.
Most lawsuits never get anywhere near these with respect to their level of legal activity. They typically get dismissed for their frivolousness or due to the inherent difficulty in proving wrongdoing. But if Drs. A through D are exemplary of the scenarios that go far enough to cause months (even years) of pain and stress to a vet, where are the truly horrific malpractice cases? OK, so the end result of these cases is bad … really bad. Yet they all could have happened to ME. Unexpected things happen unexpectedly — especially when you’re dealing with animals.
It’s a new world out there, and sooner or later, it could be us behind the big desk in some lawyer’s corner office. For my part, I’m reading the malpractice bulletin religiously. Its take-home message is always about communicating well with clients. So I figure that if I can just manage to take the time to explain, re-explain, and explain again — and meticulously adhere to our careful policies and procedures — I’ll probably stay safe. That is, unless some angry, grieving client wants my license on a platter just because I couldn’t save their unsavable pet. Unfortunately, as my colleague is learning, that’s always a possibility.
Dr. Patty Khuly