If liability lawyers had their way, I feel sure veterinary medicine would have the same hefty malpractice premiums as human doctors.

Insurance companies don't want anyone to be sued, but they sure want those premium payments.

There needs to be an honest balance somewhere.

Bad veterinarians need to be held accountable and they need to be held accountable for the actual worth of the critter. I don't mean the $100 it takes to adopt a homeless critter either. I don't mean the $15,000 spent on a lymphoma kitty. (He was worth so much more than that to me!)

Good vets shouldn't have to practice medicine with a lingering fear of being sued if something goes wrong. Sadly, our pets eventually pass away even with the best care possible. And, shockingly enough, sooner or later everyone makes mistakes.

Unfortunately there will always be clients that think the vet should do magic and the 21 year old Fluffy's failing kidneys can be fixed.

On the other hand, bad vets needs to be forced out of the business of holding lives in their hands.

I don't know the answer. It will be interesting to see what comments are made for this post.

It's early, and I'm not sufficiently caffeinated to make much sense. However, bad vets should be held accountable and removed from practice if possible. Good vets who make mistakes should own up to them and do what is possbile to fix the situation. Unfortunately, we are a litigious society who feels every wrong - or every imagined wrong - can be rectified with a lawsuit.

You're right - there is no amount of $$ that can replace your precious pet. However, there's no amount of $$ that can replace your human family member either if injured due to medical malpractice.

Keep your liability insurance. It's a cost of doing business these days.

>>Which is why right now, my insurance is expired. No biggie. I can "go bare" occasionally, seeing as I understand the reality of what’ll happen if I’m ever sued: not much. It’ll be a pain in the butt, but it’ll be over with as soon as I hand over a simple settlement consisting of a couple thou on my credit cards to cover the price of the pet in question.>>

That is because you are a small animal veterinarian. My PLIT premium is 10x yours. Re: monetary value - some of my patients are worth six figures. Many are worth five. I am also aware of one nasty million-dollar settlement for human injury caused by a horse during a veterinary procedure. That's what really concerns me: human injury, because I don't always travel with a tech. I'm worried about a horse harming the owner.

>>Yet nothing could be further from the truth when it comes to the degree to which we veterinarians are held accountable for our bad behavior. In short, we’re not.>>\

Quite true, and there is one dangerous practitioner in my region who I think should lose his license. Unfortunately, his clients don't understand his incompetence and arrogance has harmed and killed their horses. It helps that he's handsome and charming and tells them whatever they want to hear, so they buy more horses and let him maim and kill those, too. He also runs up the bill.

>>While more veterinarians are being sued overall (and I do believe that most are frivolous suits undertaken by wackos, as happens in every industry), I see veterinarians doing bad things and getting off scot-free … on a regular basis.>>

Yup. That's the other reason my premiums are so high: horse owners are disproportionately litigious. I actually don't fear my clients who own six figure horses... I'm concerned about those with cheap, poorly trained horses with no money who want me to perform miracles in the field. I've taken to immediately referring these folks to the local veterinary school and documenting, documenting, documenting.

As for getting off scot-free: yes, this happens, but I'm more concerned that this happens just as frequently on the human medical side. Just try filing a board complaint against a physician. There are no consequences for them, either.

Some examples of friends in my immediate circle who have faced lawsuits/board complaints. Identifying details have been changed:

1. Dr. A was out of town on vacation, answered her cell without thinking (her cell is not her emergency pager, but some of her clients have the number), and subsequently told the client to call her backup. The client did not do so in a timely fashion. The horse died. The client sued Dr. A. Dr. A was exonerated.

2. Dr. B prescribed peppermint-flavored bute (compounded) for a horse that would not eat bute tabs (the owner was also incapable of orally dosing the horse). The owner and Dr. B parted company for reasons unrelated to the peppermint bute, but the owner then filed a board complaint on the grounds that Dr. B had not explained the ramifications of using a compounded product. Dr. B was exonerated. The client has since filed board complaints against two other veterinarians.

3. Dr. C saw a horse with a serious injury in the field. She recommended immediate referral. The owners refused, citing money concerns, and she agreed to treat the horse in the field. Dr. C continued to advocate for the horse, and the owners sent it to a referral hospital one week after the original injury. The owners then sued Dr. C for the subsequent $25,000+ bill for multiple surgeries, ICU stay, etc., saying her treatment in the field had been substandard. The referral hospital in question did NOT throw Dr. C under the proverbial bus; the medical record from the day the horse was admitted stated clearly that Dr. C had recommended immediate referral and the owners declined. Dr. C left the area and has given up large animal practice entirely. She had been the only practitioner, large or small animal, in her underserved rural area.

In this climate, my friends and I don't have the luxury of going "bare".

To add to your list of ways to save money with your veterinarian:

If you give me weird vibes, IOW, I think you are a potential problem, I will practice defensive medicine and refer you to the local veterinary school for treatment. This will be much more expensive, but I know they will have a cast of thousands to handle your ill-mannered horse, and a team of lawyers to handle you.

OTOH, if I trust you and know you trust me, I will help you any way I can.

Who is your liability insurance carrier? I'd like to give them a call! I'm the owner of a professional pet sitting company and I have to pay WAY more than you do.

You must have a wonderful clientele, if you're not afraid they'll sue you for more than just a "few thou". These days, it seems like everyone is just waiting for an opportunity to sue someone. I've never been sued, thank goodness, but that's not to say it won't happen. I get complaints about the most trivial things you'd ever imagine, yet clients act as though I'd done something so neglectful that their pet was in danger of dying. (Not.)

I love my clients, and most of them are happy with my services and are very loyal. But, there's a small percentage of them that I know could turn on me in a second. I try to avoid clients like this, but one doesn't always know they are this way until they've been a client for some time. Then it is difficult to terminate services without causing them to fuss and/or badmouth you.

It's imperative to carry liability insurance, even though we may not care to. I wish it wasn't so, but there are plenty of starved attorneys willing to take on even a small lawsuit, if it means putting food on their table. So, like it or not, I carry liability insurance, and pray that it will be enough for the day when someone calls to tell me they're suing me because their mastiff who turns out to NOT be house trained, ruined their wood floors (even though THEY insisted upon only two visits per day). ;P

Hi - I would like to say you may be characterizing all veterinary examining boards through the wrong lens. As a hard working public member (it was again emphasized at our national meeting last week we are ALL public members) and veterinarian, the members of these boards work very hard to protect the public. There are limitations we have to work within that may look to the outside as if we are not effective. But I can assure you, this is a "job" we all take seriously.

I would be happy to discuss this more.

In the case of the dangerous veterinarian who practices in my area, the problem is the injured parties: few complain about his substandard care. If the client doesn't make a formal complaint, there's nothing the Board can do.

Most complaints and lawsuits do not address the problem of the truly bad veterinarian. Most complaints and lawsuits discipline otherwise good veterinarians who experienced a poor outcome, had a lapse in judgement, or committed a true error and unfortunately were not able to communicate effectively with the client.

As for me, I'll continue to pay my malpractice insurance policy premium - I'm not scared, but I'm realistic. In the meantime, I'll continue to practice high-quality medicine, keep detailed medical records, and send potential clients I do not trust straight to the local veterinary school for care.

>There are limitations we have to work within...

If you are hamstrung from protecting the public, who created those limitations?

Professional incompetance or negligence is a problem with, seemingly, no good solutions. Litigation is a lousy way to control the quality of veterinary care, for lots of reasons. People sue becuase they are unhappy with the outcome and assume it must be due to incompetance; they need someone or something to blame. Clients can't accurately judge the skill of their doctors. We've all seen lousy vets who were adored by their clients as well as good doctors with poor communication skills who were unpopular. And lawyers have all the wrong incentives to push litigation regardless of the the real truth of a case. The mess excessive damage awards and litigation have made in human medicine should be a warning to us not to think things would work any better on our side.

I would like to see standards of care, preferably evidence based where possible, that vets are expected to adhere to and state boards with the authority, resources, and will to enforce them actively. I am not holding my breath, however. The people best qualified to judge the competence of veterinarians are other veterinarians, but of course they can be expected to be somewhat sympathetic and biased in favor of their fellow doctors. Lawyers, judges, and lay people, on the other hand, often view medicine as much simpler and more clear cut, with right and wrong answers any competent doctor should see easily, than is actually the case. And juries are understandably sympathetic to the pain pet owners feel when they lose a companion, but this sympathy doesn't necessarily lead to appropriate rational assessment of the medical judgements made in a given case.

Not sure what the solution is, but even though I agree bad vets should be held accountable, I don't believe larger damage awards in malpractice cases will accomplish that, and I know it will raise the costs of insurance and veterinary care (to the benefit only of the lawyers involved) while driving many good vets out of practice if the demoralizing experience of an unjust lawsuit becomes an expected risk of practice as it is now for MDs.

Have you ever tried making a report to you state's board of veterinary medicine? They do have the legal oversight and the ability to inspect, levee fines, and remove licenses. Some are more proactive than others but with no report there is no potential for action.

All insurance is based on fear...which can be a great motivator to spend/invest/waste? the money.

Insurance people who look for and find ways to charge outrageous fees and or denial of claims or policies that ban any breeds are not friends of Animals or there Caretakers ,If any of you have found a Agent Of Conscience ,please share

>>All insurance is based on fear...which can be a great motivator to spend/invest/waste? the money>>

Are you suggesting Dr. Khuly is right to "go bare"?

If you were Dr. A, Dr. B or Dr. C (post 3), how would you "make things right" with each of these clients? What if you were a veterinarian in charge of a situation that resulted in a serious human injury?

None of these veterinarians anticipated that their actions might result in a lawsuit or board complaint. Each pays the annual insurance premium without complaint and passes that cost on to clients as an operating expense.

Sometimes insurance can be a help when they keep statistical accounting of risks. I think of Workers' Compensation Insurance. I was a teacher for 34 years and I remember their workers insisting on the school providing certain ladders with a frame-guard on wheels for every wing of my building. Apparently their statistics revealed that teachers were hurting themselves in falls off counters, tables, chairs and near ceilings as they put up bulletin boards and displays in their classrooms. So they insisted the unsafe practices stop and safety ladders be provided to increase safety and lower claims. Actually their observations were right on and the solution a good one. I'm sure it saved many teachers serious injuries and I know the school would not have bought the equipment were it not for incentives to reduce fees. I am sure it saved on the amount Workers' Compensation had to pay out in claims.

I can think of one risky behavior on the part of a vet. He hired my 16 year old niece to clean cages and provide water, etc. The risky behavior was her being the only provider on weekends when animals were recuperating from various conditions. She was a responsible teen but I believe this was risky and I'm sure the owners of the animals would have objected if they knew.

There is no such thing as a "service pet."

Dr Khuly,

I agree with you 100% in this article. It is misnomer that vets believe their insurance premiums will rise if bad vets are held accountable. I am in the medical field. My insurance premiums have never risen. My cat was abused by a bad vet who advertised that he is a "dental specialist" in over 7 places, including the state veterinary directory. As a result 28 of my cat's teeth were removed needlessly and she now suffers with CRF as a result of inappropriate care during surgery and after. She almost died. I am suing this vet in Superior Court. WHY? 1. He never apologized. 2. He contunes to falsely advertise his credentials. 3. The vet board did NOTHING even though in my state there is an explicit vet law that vets cannot make character statements that are false and misleading. 4. I incurred over $15,000 in damages as a results of his negligence. 5.The vet board left me with NO recourse or due process to try and resolve this issue in another manner. 6. one of the esteemed vets stated in writing that NONE of my cat's teeth needed to be pulled at all. Am I a wacko? No. This is real and this happened and I have ALL my documetation and expert witness statements to prove it. This experience has left me wondering why your professional even requires licesnsure when there is NO accountability for false advertising, fraud and animal abuse (the property vs. life is a whole seperate issue). I am NOT alone. All over the USA hundreds, if not thousands, of vets are mistreating and in some cases outright abusing animals and NOTHING happens to them. It is sick and there is a sick mindset in a vet community that this is acceptable if we "look the other way." Am I anti-vet? No, I have nice vets now who are competent. Am I anti-bad vet? You betcha! Thanks for the article.

Dr. Khuly,

I don't visit your blog often anymore. But a good friend sent me a link to this one, and I want to say a heartfelt thank you. Although I have heard you express the belief that our pets deserve to be recognized for more than "market" value before, I've never heard you so strongly agree and acknowledge that members of your profession are not held accountable for the practice of bad medicine. And yes, it is true: Not only insurance companies but "fearmongers" within your own profession, trying to retain support for the illogical positions advance by the AVMA and the state VMAs (such as: vets should be exempt from animal cruelty laws; pets should be "worth" only replacement value, etc.) has caused many members of your profession to believe that the prospect of a lawsuit, or even state board disciplinary action, is much larger than it really is. There is a part of me that thinks that, in the absence of any actual accountability, the mistaken belief that one MIGHT be held accountable isn't entirely a bad thing. But of course, real accountability would be better.

I will however, take issue with your assertion that the majority of individuals who sue vets are "wackos." I have not sued a vet, but frankly think that mine would have been a case in which, had I done so, in NO WAY could it have been considered "wacko." My most beloved cat was left with the vets son, a young man whose prior veterinary experience had apparently been limited to helping t in the kennels over summer school breaks. This person was left unsupervised to give meds, including insulin, resulting in a massive overdose to my cat. I believe I could have proved a pattern of negligence, as well as dishonesty, perhaps even fraud. As it was, I did not sue. And I am told to consider myself "lucky" that the state board chose to mete out a whopping fine of $250 (notwithstanding my out of pocket veterinary expenses for my cats subsequent neurological injuries, approximating $16,000).

I also know four or five people who have sued vets. I have learned the facts of their cases, and believe that in each one, either fraud, cruelty, incompetence, negligence or some combination of the forgoing is crystal clear. The problem is, judges et al have no choice but to base their decisions on what is pressented in court. And we all know that even the most negligent practitioners can rally a cadre of colleagues to their side as "expert witnesses" to support their arguments, however flimsy or ludicrous. The vets also have absolute control over the records, which often are the only accounting of what occurred. How convenient that so often records document conversations that never occurred, or disappear entirely (the latter having happened in my case).

Also, I believe you are wrong about vets not being able to report their peers. I have called the Florida Vet board the last time I saw you say this, and they told me that anyone can file a complaint. Vets CAN report their peers to the vet board. In fact, the AVMA principles of ethics state that if a treating veterinarian believes that the referring vet harmed the animal (not just abuse, but negligence or incompetence) he or she has a responsibility to report the referring vet.

I believe that this is another myth that is conveniently fostered in your profession, just like the accountability/liability myth. The fact is, although you CAN and SHOULD report your negligent, incompetent, abusive, or substance impaired colleagues, you don't do so because you know if you do you will be a pariah in your profession. John Robb in Connecticut started speaking out about quality concerns in your profession though his Protect the Pets site, (including the dangers of using unlicensed technicians, an issue clearly dear to my heart), and he found himself the target of visciousness and threats of loss of livelihood. Similarly, a vet in Texas who spoke out about over-vaccination and vaccine dangers, Bob Rogers, become persona non grata in most circles as I understand it.

Your culture won't change until you stand up and make it change. Your statements on this blog a positive drop in the bucket toward that end, and I thank you for that. However, I ask you to please report that vet I know you are thinking about when you rail against your inability to report a colleague, because I believe you can. You know the one. The one whose mistakes you keep cleaning up after. If you don't have the cahones to report him, then please start urging the clients who bring their injured pets to you -- injured by his sloppiness, incompetence, whatever -- and make it clear to them that you will stand by them, and stand up for the kind of medicine you have a right to expect from your profession, and your clients and their pets have a right to expect as well.

Thank you.

H. Houlahan, yes, there is such a thing as a “service pet”, to the people that have them. While the correct terminology according to various state laws may be “service animal”, these companions often times evolve into pets as they bond with their owners, and provide much more comfort than just “service”. This isn’t necessarily a blog to argue the finite definitions of the law however.

Hmmm, with all due respect! Vet board members "work hard to protect the public?" Get real. They work hard to protect their own. How do I know? When they dismiss complaints against their own, they refuse to offer an explanation. Do you know when one refuses to explain one's decisions? When there is no reasonable explanation for them. That's when.

I believe I am actually in a good position to speak out on this issue because I was an exception to the rule. With the majority of all consumer complaints dismissed with no explanation, I was one of the "lucky" ones, whose complaint resulted in a formal action against the vet, whose incompetence resulted in harm to my beloved elderly cat, Smokey. The decision took over a year, but it was the first step in closure and healing for me. I was not after money, didn't get a red cent out of this.

As a tribute to Smokey, I now offer support to the fellow victims of negligence and abuse by not only vets but vet boards as well, in my state and elsewhere. You have NO IDEA, no clue, the kind of devastation wreaked by the results of the "limitations" you have to work within (translation: being biased in favor of your own). People experience something akin to PTSD, being unable to get justice for their beloved pets harmed by vets.

So, get out of your ivory tower and look at what you are doing through the eyes of those you claim to protect! Look at the harm you are causing to those left with no justice and no recourse because you are all powerful and you have money to butter the right hand (AVMA I mean, which you are the "sock puppets" of, as someone correctly pointed out). By the way, is Hmmm your real name? Any reason you won't reveal your identity? Those who do nothing wrong generally don't hesitate to reveal their names. Hmmm...

@Natalie Kramer
This is a bizarre statement:
"By the way, is Hmmm your real name? Any reason you won't reveal your identity? Those who do nothing wrong generally don't hesitate to reveal their names. Hmmm..."

Considering that 99% of the people posting here are not using their real names. Are you inferring, then, that we are doing something "wrong?"

Hmmm, the question was not to them. It was to you. Please answer. Your attempt to deflect attention from the real issue at hand is revealing. Your use of "bizarre" is also. You cannot have an honest dialogue with a professional defending his professional position without knowing who he is or where he practices his trade. An unwillingness of a professional (as opposed to pet owners, lovers, casual readers, etc.) to reveal his identity is damning. And it is wrong!

I see that the comment was not from Hmmm but from RealityCheck. My bad. Same thing. What's wrong with being open about who you are? Afraid of something?

Posting as “Natalie Kramer” does not prove one’s identity or your professional position or your practices especially considering there are thousands of people in this country named Natalie Kramer if that’s even your real name.

Why don’t you post your email address and then if anyone wishes to engage in “honest dialogue” they will. Unless, of course, you’re afraid of something.

Will the real Natalie Kramer please stand up?

@ RealityCheck: My e-mail address is muttlover1@verizon.net. If you e-mail me privately, I'll be even more frank at letting you know what a moron I think you are.

I WILL BE even more frank telling you what a moron I think you are. Sorry. You just don't get it, do you?

I don't really think there are "thousands" of people named Natalie Kramer and quite possibly only "one" with a deceased cat named "Smokey" with a vet that could not see CHF on x-ray.

Hope I have been helpful to narrow it down.

"I would like to see standards of care, preferably evidence based where possible, that vets are expected to adhere to and state boards with the authority,.."

SkeptVet: Please do offer me the evidence based 'likelihood' of successful fluid treatment in a severely debilitated elderly dog, that presents with a blood phosphorus of 9.8 and then after 18 hours of fluid presents with an 18.0 phosphorus.

I have been searching for the evidence-basis of this actually turning into a successful life-saving treatment and can find "zero" evidence anywhere!

Are you willing to help out answer that dilemma?

Thank you, Barbara! I remember having to go in front of a judge once in a divorce of a friend. My sole role consisted of telling the judge that I could both swear and affirm that my friend was really who she said she was. Don't you wish we could "divorce" the types, who in response to serious issue, question the identity of the person willing to reveal her name, while remaining themselves anonymous? Yes, you are right, the decision in Smokey's case is available through FOIA, with my name in the body of the text in plain view.

But that's not the point really. The point is: many vets and paraprofessionals who post on the topics of vet accountability and pets' status under the law REALLY don't want their paying clients to know what they really think of the pet owning public and the status of their pets. Hence the anonymity.

As for SkeptVet's comment abut "evidence-based" standards of care. I am not sure what "evidence-based" is in this case. The standard of care for vets is defined as practices common and prevalent in the local professional community. And yes, the boards are expected to enforce those standards, WITHOUT being "somewhat" biased or sympathetic to their own. I am not sure why, SkeptVet, you believe that it's acceptable, or even expected of professionals who are called upon to serve the public with their expertise to be biased in any way at all. They should be able to leave their sympathies aside and act as professionals, as fair and unbiased arbiters, not as advocates representing the interests of their colleagues. In fact the interest they are supposed to represent is that of the pet owning public. I am an economist-statistician by trade (RealityCheck will be happy to know this), and when I am asked for an expert opinion on whether something is done correctly, my sole goal is render a professionally sound opinion, regardless of who has done this "something." If it happens to be a colleague or even a friend whose work I had to judge as incorrect, I count on this person's respect of my obligation to tell the truth. I suppose that's not the way it works in the vet world (at least according to SkeptVet), where loyalty to the fellow professional justifies being "somewhat" biased in his favor. I know that there are good and honest vets who will uphold the right principles, but the expectation of being "somewhat" biased is troublinig.

Dr. Kuhler,

You nailed it when you mentioned that there is a lack of overall accountability for the vet profession and it is "no biggie" if you don't get your liability insurance renewed immediately.

"Every profession has its bad apples. This we know. But that’s not the point of this post. The point is this: It’s veterinarians who resist the changes at the board level and in the court system. We refuse to allow pet owners recompense to more than the assessed property value of their pets, even should the courts prove that egregious damage was done.

As a profession, we reject the notion of accountability, citing pets as property. This, in spite of the fact that we enjoy a brisk trade almost exclusively as a result of the emotional value our clients place on our patients."

Unfortunately the current laws in most states do not accurately reflect societal views relating to the human-animal bond. Public attitudes and psychological evidence indicate that in our society it is pretty clear that pets are thought of more as family members than as inanimate objects or mere "property." It is time to continue fighting for the justice of our animal companions and hold those to a higher accountability who provide medical and other services for our pets. The current laws are archaic and need to be challenged.

My dog of 7 years died in June of this past year due to the gross negligence of her vet. She got out of a broken crate, made it out the back door of the vet that was propped open, and was killed 18 blocks away on the interstate (see www.rubydogclark.com) for details on this story). All that has happened thus far is a "letter of admonition" to the vet. If you look up "admonition" in the dictionary, you will see the following: "gentle or friendly reproof, counsel or warning against fault or oversight."

What is the point of liability insurance for a vet when cases this crystal clear get this type of (or lack there of) punishment? Based on Colorado case law, it has not been favorable for those suing vets in the past. It is time for change. Thanks for admitting that the vet profession "rejects the notion of accountability." If only more doctors in your profession could step forward and join the group of animal companion guardians in the fight for this to change.

LOL, "Hmmm".

I know Natalie Kramer, and I know that she indeed is Natalie Kramer.

I am Stefani Olsen, and that is also my actual name.

I am not surprised that many veterinary industry employees, chiefly vets, who post here and elsewhere choose to use "pen names." If their clients read what they really think and feel, they'd have far fewer of them.

That's right, Stefani! They won't reveal their identity because they don't want those whose business they depend on to know what they really think and believe. Their indignation at suggestions that they should be forthright about their identities speaks volumes about their honesty: they think it silly that it would even occurr to anyone that stating views under a real names is the thing to do! Impossible! In the case of Hmmmm, though, our diligent public servant, a member of a vet board in an unknown state, why do you think he or she (probably he) doesn't want his name known? Hmmmm...probably because he doesn't want people on whose cases he ruled responding to him publically. What these professionals don't realize is how this reflects on their profession as a whole. That's really too bad because the profession as a whole has plenty of good and ethical people, who will risk their alliances to stand up for what's right. My own vet is a case in point, and I am very lucky to have her (my pets too).

Short memories, people. Why are the veterinarians in this thread using pseudonyms? Just see Dr. Khuly's post from 9/23/10. Random people on the Internet with an axe to grind concern me, not my clients.

As to whether I have any worries about my clients' opinions of me, SkeptVet said it best, earlier in this thread: "Clients can't accurately judge the skill of their doctors. We've all seen lousy vets who were adored by their clients as well as good doctors with poor communication skills who were unpopular."

Posting anonymously is kindred to carrying professional liability insurance. It's a safety net against all the nuts out there, and not because they are dishonest or have something to hide.

If you don't like a blog where people post anonymously, well, you know what to do.

Posting anonymously is a form of dishonesty. You post your views without wanting to associate then with your identity; this totally ruins your credibility. Doesn't matter, does it? You are anonymous. Whether or not we like to blog is up to us, not you. Last I checked, none of us asked your permission. You are not enhancing the image of your profession. I hope you are aware of it.

>>You are not enhancing the image of your profession. I hope you are aware of it.>>

You are not enhancing my opinion of potential clients I refer elsewhere because I feel a "weird" vibe.

Keep in mind I already practice on animals with true monetary value. As I said before, I'm not concerned about working on six-figure horses; the owners are sophisticated, the caretakers are superb, and the owners generally agree to my "A" plan for diagnostics and treatment (which does not include running up the bill, BTW).

In contrast, with cheap horses, I regularly encounter the following situation, with infinite variations:

1. Owner has delayed calling and situation is now complicated
2. Owner has limited funds and cannot afford appropriate diagnostics or treatment
3. Owner is not sophisticated enough to grasp the consequences of 1) and 2), and consequently will judge me on my "people skills".

Give me a professional barn filled with million dollar horses any day of the week.

So called Equine Vet! Your opinion of me or your other potential clients is of zero interest to anyone. On the contrary, public's opinion of your profession is of interest to many people. In fact, it's the topic of this post. I would not be found ANYWHERE within shooting distance of your practice, not only because I don't own horses and don't believe in owning pets that are of monetary value (mine are all rescued) but primarily because I would not pay a single red cent to someone who doesn't have the honesty to post under his own name; someone who holds the beliefs that you do; and someone who can POSSIBLY agree on ANY topic with Dr. Brennan McKenzie (SkeptVet), who(to put it mildly) practices the dubious trade of pheramone therapies and esoteric homeopathy. I can see why he would post under a pen name here. I am done posting on this topic as I will not be arguing with your likenesses anymore. I am glad I had an opportunity to allow "normal" pet owners a glimpse into what can lurk out there under the guise of being a member of a "noble" profession. Ever since my pet was killed by incompetent vets, I have sought to raise awareness of bad vets, of vet quacks, and of vets with dubious characters. You make my job easy. At the same time I am grateful for the good, hardworking, and honest vets who devote their lives to the true healing of our pets; seeing what exists under the guise of a vet makes me appreciate them even more.

@Natalie Kramer

Whining about anonymity is just a way of avoiding dealing with the substance of what someone says in favor of attacking them personally. As you have seen, finding out who I am isn't difficult, and since a link to my blog is posted on my practice website, I'm clearly keeping no secrets from my clients. I do prefer to avoid the ravings of the self-righteous and ignorant such as yourself. The incoherent rant that you posted on my blog, for example, complaining about how I was a quack for using pheromone therapy and homeopathy, was bizarre considering the posts you refered to were both about the absolute lack of any convincing evidence that these therapies work, not about my using them. If you can't be bothered to read what I write, regardless of what name I write it under, than you've no right to an opinion on it.

Just got back from beautiful Costa Rica. And while I love that this post has received a lot of attention in my absence, I'm disappointed to find that the back and forth here has been less than civil.

I haven't decided whether to delete all these hostile comments on the issue of identity, etc. but I will definitely say that any future comments in this vein will be promptly deleted.

We can't possibly function as a community that embraces positive change on behalf of our pets if we don't play by the basic rules of a civil society. Keep it respectful and non-personal, please.

As they say (and I ineptly paraphrase): Be tough on the message, not the messenger.

While I do feel that dealing with pets strictly as property does not do justice to the bond that we vets build our lives around, I also do not believe in "emotional damage" awards. Before someone jumps over me, let me make the statement that I feel this way about human AND veterinary medicine, despite my mother dealing for the last 20 years with the results of an incompetent surgeon.

I believe in penalties that work to correct the problem. Certainly monetary recompense for the cost of replacement (which, by the way, I feel for a companion animal should include not just the cost of obtaining the new pet but perhaps the cost of spay/neuter for the new pet and the cost of getting it up to date on vaccines) and/or any medical costs incurred as a result of the mistake. Beyond tangible monetary costs such as this, I think penalties should be along the lines of suspension, continuing education, and probation.

The reason I am so leery of emotional damages is that they are essentially limitless. How much money would it take to make me stop hurting if that surgeon had botched my mother's surgery even worse? It couldn't be done. Should a doctor or a vet be made to pay forever or give up their livelihood (in which many of the newer generation have invested well over a hundred thousand dollars and years of our lives) because of a mistake? Except in the case of intentional harm or egregious inexcusable incompetance, I don't believe so. It won't undo what's been done, it just ruins a second life. If non-tangible awards become standard in veterinary malpractice, there should be a reasonable cap on it.

Except for this bit ("As for getting off scot-free: yes, this happens, but I'm more concerned that this happens just as frequently on the human medical side. Just try filing a board complaint against a physician. There are no consequences for them, either."--because believe me, there are PLENTY of unpleasant consequences) I agree with most of what Equine DVM said. I am a physician for human patients, and so much of what he said about clients/patients is true. In the human medical practice, there are so many times when patients receive suboptimal care directly because of (1) the patient insisting on unncessary tests/treatments, (2) the patient insisting on suboptimal treatments because they don't want to do what's medically recommended, (3) or the patient simply not following instructions from their doctor. And then the patient sues the MD when something goes wrong. Safety and peace of mind, these days, goes with detailed, exhaustive documentation on discussions of all risk and benefits of all treatment/diagnostic options discussed with the patient, as well as alternatives to recommended treatment, including but not limited to......you get the point. This takes up a HUGE amount of my time. And guess what, you don't get paid for this (just as you don't get paid to return the massive number of patient phone calls, patient requests, and lab followup.

The veterinary profession should learn from what has happened to MDs....I am not sure what the actual solution is, but it would be a shame if what's happened to us in the legal arena ever becomes a reality for the veterinary community.

It is VERY rare for anyone to be aworded emotional damages in relationship to losing a pet. Usually it is the actual damages (over $15,000 in my case plus interest and penalty) that is sought. I agree with you that suspension, loss of license and other punative disciplinary actions are warranted. However, the majority of vet board complaints are summarily dismissed even when the evidence proven is overwhelming. This leave pet owners with "no place to go" (for justice) but a civil suit. I think if your profession did a better job at cleaning up the bad apples, this would not be the case. My experience has led me to now view the vet profession in a similar way as the Catholic church. The church knew priests were molesting children. What did they do? Turn a blind eye and tranfer the priest. This makes them just as responsible as a the molester. I see the same behavior with vet boards. They KNOW the vet is a bad apple so what do they do? Turn a blind eye and "hope it all goes away." The public is on to this thinking and won't have it anymore. If I got an apology from the bad vet who abused by cat, it would have gone a long way. I got nothing from him or the vet board even thought he CLEARLY broke the law in my state. Criminal in my opinion.

sorry for the typos. i hope you get my point.

Othersideofthefence: If you keep good, accurate, detailed progress notes you hsould not have to worry.

"suboptimal care directly because of (1) the patient insisting on unnecessary tests/treatments, (2) the patient insisting on suboptimal treatments because they don't want to do what's medically recommended, (3) or the patient simply not following instructions from their doctor. And then the patient sues the MD when something goes wrong."

That is not something I have ever heard:

It is a. my doctor is making light of my issues and refuses to look further or b. I am passed around for a piece of the pie to do these same exact tests over and over as if the result will change.

I have two family members that have met a and b.
One that was dismissed for back pain based on a radiograph and the patient requested MRI showed vertebrae fractures, herniated disk, and spinal cord compression (i think a second look in retrospect on the radiograph also revealed an "issue")

and b. the same upper & lower gi series , endoscopy, at two different locations revealed ZERO for a blood "loss" in a cancer patient...

Sue? Neither one had entertained any thought of a Board complaint, nor lawsuit then, now, or in the future.

It takes a pretty darn upset and wronged person to go with either, that is my firm belief and opinion, especially in the veterinary medical field.

..."Except in the case of intentional harm or egregious inexcusable incompetance, I don't believe so. It won't undo what's been done, it just ruins a second life. If non-tangible awards become standard in veterinary malpractice, there should be a reasonable cap on it..."

And a third and a fourth and a fifth....

When/where do YOU draw the line? Some rotten eggs should NOT lay a finger on an animal and everyone knows it, including the vet boards that do ZIP, zero, zilch!

>>Should a doctor or a vet be made to pay forever or give up their livelihood (in which many of the newer generation have invested well over a hundred thousand dollars and years of our lives) because of a mistake?>>

Precisely, because as I've already stated:

Most board complaints and lawsuits do not address the problem of truly bad veterinarians. Most board complaints and lawsuits are against basically good veterinarians who made a mistake, used poor judgment, or had a bad outcome.

Beware the bad veterinarian with excellent people skills... but good luck unmasking him! Perhaps some of the anger from laypersons in this thread derives from fear. It's easy to attack a veterinarian for her people skills or opinions, but virtually impossible for a layperson to judge the quality of her veterinarian. I'm aware that most of my clients have no idea of the quality of the medicine I practice, but they certainly know whether I smile and make pleasant conversation. So I try to be nice, even though I like horses much more than I like people (which is just one reason I'm not a physician).

Re: Othersideofthefence

A member of my family was badly injured by a physician's mistake, without consequences. I don't think she was a "bad doctor", but she made a mistake. Given the same situation, most of the veterinarians I know would have apologized and offered to make things right, but the physician also behaved badly (n=1). Given my colleagues' experiences with lawsuits and board complaints, I don't think the penalties for physicians are more strict than for veterinarians, though human malpractice lawsuits certainly are larger monetarily. In most states, however, physicians win 95%+ of malpractice lawsuits that go to court, and the Board in my state rarely disciplines physicians.

>>I don't own horses and don't believe in owning pets that are of monetary value (mine are all rescued)>>

That's your choice. Many of my clients' horses have no monetary value. Some horses were valuable at one time and lost their value, due to age, illness or injury. Some of these continue to live alongside six-figure horses in excellent management situations.

The point is that I practice the same standard of medicine regardless of the value of the horse, and the cost of care is also the same. Or I attempt to do so, though owners sometimes do not allow me this freedom.

Above, I cited two examples of a "mistake" in human medicine.

If you care to educate your self on the "perceived fear" of clients, I only suggest you read "badvetdaily.blogspot.com"

These are public record examples of gross: incompetence, negligence, fraud, malpractice and yes, downright "cruelty" that no client would ever choose to do business with, if they knew of such abuse.

ALL of these cases cite veterinarians that are still in practice. I guess a perfect example would be the TN. vet "Baber", filmed on videotape horrifically euthanizing animals, tossing them aside to "writhe in pain". Now are you suggesting that is a "mistake"?

I think not, however the Board of VM , reissued his license shortly after, didn't they?

No, some of us do NOT have perceived fear, some of us actually experienced that fear to the most horrific degree.

And please do not suggest that 95% of human malpractice is "won"; the simple truth is 95% reach "settlement"---not that has do do a whit with veterinary malpractice, it doesn't.

>>please do not suggest that 95% of human malpractice is "won"; the simple truth is 95% reach "settlement"---not that has do do a whit with veterinary malpractice, it doesn't.>>

Re-read what I wrote in my earlier post, this time more carefully. You did not read it correctly the first time.

Actually, if you agree neither bad physicians nor bad veterinarians are adequately disciplined, you'd realize the information I actually presented is supportive of your stance. Whatever.

@ cat guardian: Yup, it is rare, which is what Dr. Khuly is referring to by saying legally pets are only “worth” replacement value. I’m simply saying that I don’t believe they SHOULD be awarded, because emotional damages are nebulous. How much is a family member “worth?” I certainly can’t put a number on it, which is why emotional damages are simultaneously ludicrously high and ludicrously inadequate. I agree that major reform of the veterinary board system is needed. It’s easy to say and recognize but harder to do. As Equine DVM says, very few laypeople are qualified to judge whether adequate care was given. Most client complaints I deal with in my own hospital are due to unreasonable expectations or poor communication rather than poor medicine. Do some bad vets get off? No doubt, and that should be stopped. Are all the board complaints that get dismissed the result of vets protecting their own? No. The hard part is judging objectively from the outside which is which. A catch-22: the only people with the technical medical knowledge to judge whether an error had been made or a vet has been negligent are the people most inclined to be lenient. Any ideas for how to effect better self-policing?

@ BarbaraA: Did I ever say that I think truly bad vets should not lose their licenses? I do not believe that a single error, though tragic, should justify removing a person’s livelihood unless it is either malicious or truly dangerously idiotic (e.g. telling a person whose dog was hit by a car that it’s nothing to worry about). Expecting any profession to have infallible members is unrealistic. Expecting the members of a profession to do their best to make good on their errors is reasonable. I don’t know where I draw the line, it depends on the severity and frequency of the mistakes in question. Making the same fatal mistake more than once? Probably a bad vet. Making fatal/potentially fatal errors daily, weekly, even monthly? Probably a bad vet. Making any mistake calls for an examination of what led up to it and how to improve operations, and potentially remedial training if it was due to a gap in knowledge rather than a problem with protocol.

Personally, I would like to see minimum standards of care established as the best way of determining whether malpractice has occurred. This will, however, lead to some potential consequences: a) only people who are able (read: well-off) to meet the standard of care will be able to have pets, as vets will refuse to practice below that level and meet people halfway with budgetary constraints; b) owners should be ready to acknowledge that if THEY are the reason a standard of care is not being met, they should be ready to be sued; c) more euthanasia as people are unable to meet the minimum standards; d) more owners avoid veterinary care knowing that they cannot afford the radiographs and bloodwork that are the standard of care for, say, a vomiting pet.

Re-read what I wrote in my earlier post, this time more carefully. You did not read it correctly the first time.

Actually, if you agree neither bad physicians nor bad veterinarians are adequately disciplined, you'd realize the information I actually presented is supportive of your stance. Whatever.

Yes, I DID read your carefully worded statement the first time. The little phrase "go to court". However , I believe for general readership, the statement implies that:
1. most cases DO go to court
2. and that most are won by physicians. I do not agree with either.

Yes, I did notice your opinion that "regulatory boards" in general do not do their job. However, regulatory boards can not turn a blind eye to everything in the human side. And if they do, there is still meaningful recourse available in the legal forum.

wikith: Sadly c & d have been happening for the last several years all over the country


Oh and I notice not one Vet is willing to answer this question, particularly since I don't know any real people behind the alias, why not answer? It's not like I'm going to benefit from free medical care? Ok then, I'll try again?

Please do offer me the evidence based 'likelihood' of successful fluid treatment in a severely debilitated elderly dog, that presents with a blood phosphorus of 9.8 and then after 18 hours of fluid presents with an 18.0 phosphorus.
What is the reasonable prognosis of going on to live a treatable life? Percentage?

We have a long-standing saying in the USPS for someone that has committed a breach of public trust:

Thius may be the "first time" you have been caught; we do not believe this is the first time you have committed the "crime, fraud, etc.".

>>Yes, I DID read your carefully worded statement the first time.>>

Accurate reading of my post was not reflected in your earlier reply.

>>The little phrase "go to court".

Yes. That's important. Cases that go to court are cases plaintiffs' attorneys think they can win, based on the evidence and expert witnesses they have available. Malpractice attorneys are usually paid a percentage of the settlement, which only happens when they win.

>>However , I believe for general readership, the statement implies that:>>

I implied nothing. I clearly indicated I was discussing cases that actually go to court, as many seem to think allowing emotional damages - which would provide a greater incentive for attorneys to become involved - would result in fewer "bad vets" and greater satisfaction on the part of plaintiffs. Based on what has happened in human medicine, that is likely not the case.

>>1. most cases DO go to court>>

As you noted, about 90% of cases that aren't dismissed or dropped are indeed settled. I never disagreed with this fact, (about 60% are dropped for various reasons, though). The NEJM published an interesting paper (5/11/96) discussing closed cases (both settlements and lawsuits):

3%, no actual injury to the patient
37%, poor outcome, but no error committed

IOW, about one-third of human malpractice cases that receive awards are groundless. I have no reason to believe veterinary malpractice cases would differ, and agree with Othersideofthefence here.

>>2. and that most are won by physicians. I do not agree with either.>>

You are wrong. I've heard this from clients who are attorneys, but I refer you to the esteemed source, Wikipedia, Medical malpractice, final paragraph: overall, in 90% of cases that actually go to court, physicians are found "not negligent".

>>regulatory boards can not turn a blind eye to everything in the human side. And if they do, there is still meaningful recourse available in the legal forum.>>

See NEJM and numerous other sources. The human medical malpractice system works poorly for reasons beyond the scope of this discussion.

>>Please do offer me the evidence based 'likelihood' of successful fluid treatment in a severely debilitated elderly dog>>

Why was this dog presented to the veterinarian in a severely debilitated state?

>>that presents with a blood phosphorus of 9.8 and then after 18 hours of fluid presents with an 18.0 phosphorus.>>

What happened to the phosphorus level after referral and continued IV fluid therapy?

>>What is the reasonable prognosis of going on to live a treatable life? Percentage?>>

Depends upon the patient. My elderly cat's phosphorus levels hovered in the high teens for a few days while she was having an acute crisis (we knew she had been in chronic renal failure for a while, but that wasn't her primary problem). Her cat doc and I tweaked her maintenance regimen and she lived another good year, playing with her catnip and sleeping in the window.

Every patient is different. We didn't quit with my cat because she was in good body condition and responded quickly to appropriate treatment.

Like most veterinarians, I look at the patient, not the bloodwork. I've euthanized dying patients with perfect bloodwork. In contrast, there are horses alive today in my practice who lived through terrible crises; their owners keep the lab reports as souvenirs.

BarbaraA, I assume that when you want an evidence-based answer, you want some sort of study of this very specific situation. The reason we haven't answered is because there is no study. I don't have the foggiest idea from a pure evidence-based perspective, which is why I declined to answer. My gut? Prognosis very guarded based on progression despite fluid therapy, but further treatment depends on a lot more than numbers on a sheet of paper. Medicine is not a particularly clear-cut field - I've seen animals that should be dead pull through and animals with only seemingly minor problems fade away despite great bloodwork and a good prognosis.

I agree that c and d from my list are already happening, and it breaks my heart and frustrates me. I try not to judge people for not being able to afford the best care, as long as basic preventive care is maintained, but in return I like not to be judged for trying to offer the best care. The best care is frequently turned down, usually without major consequences but sometimes resulting in serious harm that could be otherwise prevented. A lot of people seem to want everything. They want to have all potential outcomes explained and exact likelihood of each outcome, they want each test explained and the reasoning behind it gone over in depth, they want us to predict what the results are likely to be so we run only the tests we need and none we don't, they want it all to be done quickly and oh yeah it all has to be affordable to the average pet owner. And if something goes wrong, the vet should have known it wouldn't work or should have known if might be something else and they want to stick it to the vet for emotional damage and/or keep the vet from practicing ever again because if they made a mistake or error in judgment they're incompetent and a danger to animalkind everywhere. I know we want to believe our doctors are either infallible or awful but the vast majority are neither and if you only want the infallible ones practicing you are going to be waiting in a damned long line.

There are undoubtedly bad apples out there who should not be in charge of life and death decisions but you will never, ever get me to agree that mistakes leading to poor outcomes should be the one and only way to judge which those people are. I am truly sorry for whatever happened to your dog. Whether it was truly caused by a bad vet, a good vet who made a mistake, or simply something that was unlikely to have been salvaged, I am not competent to judge unless I read through the entire medical record. Whatever the truth, it is always tragic to lose a family member, especially if you are left with questions afterward.

Not sure if this is “evidence based”, but real life experiences are sometimes the best knowledge I can readily rely upon. I have a kitty that went into chronic renal failure, and her phosphorus, creatinine and BUN levels were extremely elevated (she was almost 13 at the time). She stopped eating, was lethargic and was vomiting white foam all day long.

My vet kept her for 24 hours in the hospital and administered fluids through an IV. After 24 hours, her values were still highly elevated.

The vet called me in for a consult and asked me what I felt we should do: continue for another 24 hours with the fluids, or take her home for her last days, or PTS now. My response was, to do everything we can for her. So we continued the fluid therapy for another 24 hours.

After the next 24 hours, her elevated values dropped dramatically. We then continued for yet another 24 hours, after which time they were almost normal.

What we didn’t know at the time (February, 2007), was that she was being fed the melamine poisoned cat food from Menu Foods (Nutro to be precise) and her renal failure was due to the crystals built up in her kidneys. Had we not continued the fluid therapy, we never would have flushed the kidneys appropriately, which turned out to be the only therapy available for all the kitties that had consumed the melamine contaminated foods.

My experience with vets is that they ask you how you want to proceed, and can only offer their professional opinions on the outcome of the treatments you authorize. My kitty is still with us, and I often think back on the situation and thank God I decided to do everything we could for her.

>>I know we want to believe our doctors are either infallible or awful but the vast majority are neither and if you only want the infallible ones practicing you are going to be waiting in a damned long line.

There are undoubtedly bad apples out there who should not be in charge of life and death decisions but you will never, ever get me to agree that mistakes leading to poor outcomes should be the one and only way to judge which those people are.>>

Very well-said, wikith.

RealityCheck: As wikith said, and as you and your veterinarian know first-hand, in medicine, it's difficult to predict which patients will live and which will die. Sometimes you win. I'm glad your kitty did well.

Well, the three of you that chose to comment on my question , all but one did not deal with "actual" numbers.

Wikith: I admire your carefully guarded answer. However, there is certainly a study published in the Veterinary Internal Medicine Journal.

Very simply, a dog (not cat) is in end stage renal failure, whether caused "acutely" by another condition (such as cancer, etc), and the prognosis is poor to "impossible". This would be the same as in humans , (Equine DVM), as published in the New England Journal of Medicine. I respectfully suggest that you are disingenuous with your answers.

RealityCheck: I can only suggest to review your paperwork to say for sure what :really elevated means numerically". As a matter of fact, I had to pull out comparison records myself, to see what one Veterinarian cited as fatal and another as "treatable" and was quite surprised myself.

As far as the "whole story"? Soon that will be public record for all to judge for themselves. Me? Well, I have had many dearly loved pets in my life that have passed on, but none have I considered "tragic" as this one truly was. Prolonged suffering, absent pain management, and a horrific inhumane administered death in my presence, this is "no" isolated mistake.

I am remiss in not commenting about c & d. I agree that it has to be horribly frustrating and increasingly sad to be a professional dealing with c & d. I run into those ugly stories from pet-owners and become disgusted myself.

However, when you are fortunate to have that "client" that wants to do right by their pet and does feel that pet is valued and DOES have the resources... why on earth would any VET disgrace that trust just to make the quick $ , and/or for other motives equally disgraceful?

Particularly, when that very person has SIX more pets equally loved in the household? That is just "complete moronic" behavior, not to mention "fraudulent, cruel, and abusive".

But unfortunately for you, it tends to stink up your whole profession, while you idly sit by.

>>Very simply, a dog (not cat) is in end stage renal failure, whether caused "acutely" by another condition (such as cancer, etc), and the prognosis is poor to "impossible".>>

Poor prognosis does NOT mean a veterinarian should not offer the option to treat; in fact, we are encouraged to present all options to clients. I've seen more than one patient with a poor prognosis survive and enjoy good quality of life. I've also seen patients with a good prognosis die despite excellent care. That's not easy for clients to accept, either.

Response to supportive treatment of chronic renal failure is not impossible, but it is very individual. Some patients do well and survive for prolonged periods with supportive care, and some don't.

No veterinarian is psychic. I've been wrong more than once.

>>This would be the same as in humans , (Equine DVM), as published in the New England Journal of Medicine.>>

No, it really isn't the same in humans: we routinely offer renal transplants and dialysis to humans. Veterinarians generally offer IV fluids then SQ maintenance fluids when first presented with a patient in renal failure, primarily because more extreme measures are very expensive and not widely available.

>>As a matter of fact, I had to pull out comparison records myself, to see what one Veterinarian cited as fatal and another as "treatable" and was quite surprised myself.>>

Chronic renal failure is treatable until the patient fails to respond. In order to determine that a patient isn't responding to treatment, it is necessary to attempt to treat the patient.

>>As far as the "whole story"? Soon that will be public record for all to judge for themselves.>>

Excellent.

>>Prolonged suffering

Sorry, I don't think a week of hospitalization with IV fluid support constitutes "suffering". I've done it with more than one of my own animals. Of course, I am not you. If you didn't want your dog to be hospitalized, why didn't you take her home rather than bringing her to a referral hospital?

>>absent pain management

Chronic renal failure causes nausea and weakness. It's not a painful illness. One of my human friends died after living with chronic renal failure for a decade. He felt tired and had no appetite, but he wasn't in pain.

>>a horrific inhumane administered death in my presence

This should be easy to prove or disprove from the medical records, as well as from purchasing records for the hospital. Sadly, I think you are mistaken here.

You enjoy being argumentative and an authority. I am worried about you. Perhaps you should consider a "law" degree.

Actually, I don't mind, It is good practice.

Renal failure is not painful? I think you should ask some end-stage human patients. Oh, ones that don't get pain meds, are there any? How about peritonitis? Not painful?

What do you call responding to treatment? I sure hope it means a patient that can eat & digest & eliminate non-bloody stool? (animal, that is).

Proving inhumane death? Well, what would prove that? What would be normal for any clinic to provide to "prove" that? Besides a type written record, 2 years after the event, that is?

>>Renal failure is not painful? I think you should ask some end-stage human patients. Oh, ones that don't get pain meds, are there any?

One of my friends died of chronic renal failure. My aforementioned cat died of chronic renal failure, as did a dog I owned many years ago. All were nauseous and weak, but not painful.

>>How about peritonitis? Not painful?

Peritonitis is an entirely different problem, and would be an unusual complication of chronic renal failure. How was your dog diagnosed with peritonitis?

BTW, you never answered one of my original questions: why was your dog originally presented to the veterinarian in a debilitated condition?

>>What do you call responding to treatment?

Depends on what the patients' problems are.

If you didn't think your dog was responding to your veterinarian's treatment and felt she was suffering, why did you elect to continue treatment elsewhere?

>>Proving inhumane death? Well, what would prove that? What would be normal for any clinic to provide to "prove" that? Besides a type written record, 2 years after the event, that is?>>

Let's see: medical records, a record of ordering euthanasia solution, and a controlled substances log.

Those are reasonable questions. To me debilitated means old, sick, and dying. I brought my dog to confirm that and request euthanasia, as I have with the many pets before and after her.

I did not seek treatment elsewhere, it was insisted that I "confirm" their diagnosis by obtaining an ultrasound at a referral hospital of their choice.

Being a long-time and cooperative client, I went, all by myself.
My dogs condition rapidly deteriorated, it was a nightmare. The chain of events spiralled downward.

Do you expect your long-time clients to follow your wishes?
Do you also choose to make the *very* best decision and referral for the well-being of your patients? Do you respect the trust, cooperation, and hard-earned dollars your clients pay?

I hope your answer to all 3 is a resounding "yes". But realize that not everyone wears that outfit.

No one suffers more than me for what happened. As any surviving victim, the torment of being "stupid" and if onlys never leave.

My friend's elderly & ill Dad called it quits to dialysis, it was painful, a long death process, and plenty of suffering. Drugs were given continuously. Perhaps your friend was hugely stoic, as most animals are.

I guess my answer above combined with a sneek peak at my web site says it all, no more comments, I suppose, "equine dvm"?

Of course not every thing is posted that could be: such as radiograph, etc, etc...but enough to make an educated guess anyways.