Pet patient disasters and the ready use of the word 'malpractice' in vet medicine
I got to thinking I'd been spending too much time with lawyers recently when a colleague’s recent disaster case had me wondering…is this malpractice?…or is it just one of those inexplicable things that happens in animal medicine? On first blush, it sure seemed like a classic case of sloppy care. (It happens, I’ll admit.) But as with everything else in this case, the real answer was lying just beneath the surface.
The owners had brought me their sick cat when his regular vet couldn’t understand why he kept licking one leg raw. (Not such a big deal, right?) I examined the [very] feisty feline and saw a deep, angry sore around an area about two inches long and one inch wide on the front of his right leg.
Since dogs often lick this area frequently, creating sores we call “acral lick granulomas,” I immediately assumed this cat was doing the similar obsessive-compulsive type behavior that can occasion these self-traumatic sores in dogs. Cats can do similar OCD-type things but usually they lick in a bilaterally symmetrical pattern. They don’t tend to go to town on one spot alone—but sometimes they do, hence my hypothesis.
After getting a basic history, however, it became clear that there might be other reasons why he’d be worrying his leg. This big, raucous male had been hospitalized three months earlier when he’d been “blocked” (which means he’d been unable to pass urine through his urethra), a life-threatening emergency his regular vet treated successfully. Kitty had since done well, urinary-wise, and his grateful owners had been loath to leave their previous doctor but for this one, nagging issue.
I offered to sedate the wily kitty so I could examine him thoroughly, but the owners were less than thrilled by this suggestion. To no avail, I pressed the point, knowing I’d never get a good exam on this animal without a hefty tranquilizer (hell, I might even need a dart-gun for this beast). They finally relented when he lunged for my chest (there’s nothing like seeing a sick pet try to tear up his vet’s bosom to convince owners that he needs drugs).
It was only after a dose of Telazol that I could approach this cat without leather gloves…and I’d have never found the telltale lump without it. Under his raw skin, I felt a little firm bulge that moved slightly when palpated. After taking an X-ray, it was clear that there was some little linear bit of foreign material there.
The once-reluctant owners were excitedly gung-ho about the possibility of a surgical cure after I showed them the X-ray. Still deep asleep, this kitty was in perfect condition for a dose of pain reliever and a scalpel. A few slices later and I’d extracted it: As I suspected by now, the offending object was the tip of an intravenous catheter.
In case you don’t know, it’s this kind of vet-originated item, coupled with the inability of the installer to find it, that makes owners scream “malpractice!” faster than you can say “accident.” They were not easily consoled, though I daresay they weren’t the most reasonable people to begin with.
My take on this case? One difficult cat (to put it mildly) plus one IV catheter equals one chewed out catheter. In fact, the owners reported that he’d had catheters in both his legs during his stay. Indeed, if you looked closely, his fur hadn’t entirely grown back on both legs where they’d been shaved for the procedure. One catheter had likely gone “missing” at some point, thereby necessitating the other.
So you know, pets often resent the presence of a tube attached to one of their extremities. Occasionally, they rip the whole darn thing out with their teeth—it’s almost always extracted in one piece (indeed, it’s hard to imagine how they’d accomplish it otherwise). This cat somehow managed the unlikeliest of IV catheter mishaps.
Do I fault the vet for not finding the indwelling bit of plastic? No…not really. He’d have had to sedate an aggressive cat (whose owners were adamantly anti-sedation) for a very low-yield investigative procedure. Moreover, second-opinion vets often have the luxury of exploring in ways some [difficult] owners won’t accept from their regular vet.
And as for being ready to play the blame game, I’m always slow to take the bait. After all, next time it might be my catheter that ends up inexplicably rattling around in some cat’s body. As my mother famously says, “Don’t spit upwards. It might just land in your face.”