Here’s an ethical dilemma on what might otherwise be a boring Tuesday:

A new client comes in with a dog whose leg has been broken since last February. Though the leg sports an impressive external fixator device (one of those scary but sometimes necessary tools used to piece a broken leg together), it’s clear this semi-young dog’s leg ain’t fixed (he isn’t using the leg at all).

You spend twenty minutes downloading the complex story from the owner. Here are the basics:

She finds the dog five years ago on the street with a broken leg. $2,500 in surgery later the nerve that was accidentally sliced in the process leaves him with a club foot.

The neuter surgery for his cryptorchidism? They couldn’t find the abdominal testicle so they told her it must not be there. Yet we can infer the dog is still intact by the way he responds to females in heat in his neighborhood. She still got charged an extra $250 for the “complicated” neuter.

Dog’s leg is broken in a sofa-recliner accident last February (same leg as the first time but a totally different bone). $4,000 later she’s told it’s healing fine. Months go by. X-ray after X-ray, she’s told the leg is “trying to heal.” Last week (9 months later) they finally told her another surgery was needed to “finalize the healing process.” Another $2,500.

Alternatively, she could elect an amputation for $2,000.

The last straw, I guess. That’s when she takes her manicurist’s advice and comes to see me.

Not that I’m much of an orthopedist, but I can tell this leg will need at least 2 surgeries and a LOT of physical therapy to save it—if she’s lucky. While the most recent bone was “trying to heal” the old fracture site (which was incompletely handled, to boot) has formed a crazy bond with the nearby hip joint. The hip doesn’t move at all. And the club foot? It’s not helping any.

So I ask an innocent question (sort of): Who was the surgeon?

Turns out she saw the surgeon on the two orthopedic surgeries exactly once before each of the procedures. She was impressed with his credentials, she says. She tells me his name.

He’s no board-certified surgeon. He’s got no stellar credentials. His claim to fame is offering his surgical skills, such as they are, to veterinarians who prefer not to refer their patients to board-certified surgeons so they can turn a buck on the ancillary surgical services (fluids, antibiotics, hospitalization, pain medication, etc.).

He’s a ghost. He comes in, charms the clients, performs the surgery in a general practice facility and leaves. Needless to say, his complication rate is high. Some owners complain. But most don’t. No one ever takes him to task—least of all the vets who use his services, complicit as some of them are (though by no means all) in misrepresenting his credentials.

His rates? They’re higher than for any of the boarded veterinary surgeons I know. His overhead? Not much—one tech and some specialized equipment. He’s raking it in—no doubt about it (but I guess that's beside the point, isn't it?).

So here’s the dilemma: I hear of one case like this dog’s (out of this practitioner) every couple of months. True, I keep my ear to the ground, but I’ve got to guess my knowledge is just the tip of the iceberg.

Do I…

a)    Call the Board of Veterinary medicine and lodge a complaint.

b)    Urge the owner to call the Board and lodge a complaint.

c)    Do my best to let the owner know how egregiously mismanaged her dog’s case was and explain the surgeon’s inadequate credentials so she can do what she sees fit.

d)    Offer to amputate the leg for $700 and call it a day.

Unfortunately, option “a” is unavailable to me. I’m not the aggrieved party and cannot testify to what this owner was told and I have no access to the records which might elucidate the true facts of the case.

Option “b”? It’s a possibility. But if things go sour in any way and I’m found to be behind the complainant’s complaining, I could theoretically be sued for defamation.

Option “c”: Sure, I run the same risk as in “b” but as long as I’m not actively encouraging the owner my chances are higher of coming out of this unscathed. Does every vet in town have the potential to know I was involved? Perhaps. Will I be pilloried for my position, given that a large number of hospitals use this man’s services? Maybe. Is anything the Board might do be likely to mend this “surgeon’s” ways or protect more pets? Not likely.

That’s why “d” was my answer for this case.

Though some of you might suspect that vets don't complain against vets and that it's our inherently unethical self-preservation that's the root cause here, I'd submit that you consider the complex nature of the machine. It seems, the more I think on it, that our industry's just not set up for appropriate peer review or safe whistleblowing.

Unless drugs, alcohol or blatantly illegal activity is involved, a vet's anonymity is not preserved when he/she requests an investigation into another veterinarian's potentially harmful activities. There is no system for raising questions, even when an entire community is involved. Other professions offer greater protections but mine isn't one of them.

Your thoughts?