Case study: Outside of scope

29 August 2024

A four-month-old dog was taken to a veterinary clinic for emergency care, after it jumped from a moving vehicle and was injured.

The veterinarian who treated the dog was a mixed animal veterinarian working in a practice that focused on production animal medicine. They performed a physical examination of the dog, took radiographs (lateral and ventrodorsal views), and administered pain relief and antibiotics. The veterinarian told the client that they had limited experience taking and interpreting canine orthopaedic radiographs. Their interpretation of the radiographs was that the dog’s hip was not dislocated and it had no displaced fractures.

The veterinarian told the client that the growth plates in young dogs can make radiography interpretation difficult, and said that they could not rule out a non-displaced fracture. The dog was discharged with pain relief and the client was advised to bring their dog back in two days if there was no improvement. 

One week later, the dog was bought back to the same veterinarian. The veterinarian recommended repeat radiographs, and said they would be best taken by another veterinarian at the clinic who had a special interest in orthopaedics. However, the in-house orthopaedic veterinarian, and external specialists, had limited availability because of the holiday season. 

A follow up consultation was scheduled for the next week and the patient was seen by a different veterinarian at the same clinic who took more radiographs. They diagnosed a fractured left femur and referred the case to a specialist.

The dog’s owner made a complaint to the Vet Council which was sent to the Complaints Assessment Committee (CAC). The CAC is a preliminary screening body that decides what should happen next with a complaint. The CAC can conduct a formal investigation and decide what steps, if any, need to be taken to ensure the veterinarian is fit to practise and public interest is protected.

The owner was concerned that the veterinarian who treated their dog was unable to identity the broken bone from the radiographs, and that the veterinarian did not suggest further radiographs, investigation, or a treatment plan.  

The Veterinary Services part of the Code says that veterinarians in clinical practice must make an emergency service available for their clients’ animals to receive essential veterinary treatment to relieve unreasonable or unnecessary pain or distress.

The emergency service must be sufficiently resourced so that unless there are extraordinary circumstances, all veterinary emergencies involving clients' animals are attended to in a reasonable time to ensure the animal’s welfare.

There is complexity in cases where the clinical skills required to manage the emergency are outside the veterinarian’s competence.

When reviewing a complaint, the CAC measures the veterinarian’s conduct against the standard that is expected of a veterinarian practising in similar circumstances and the expected professional standards.

In a veterinary emergency, a veterinarian's involvement should be tailored to their competence and the resources available. If they don’t have the particular clinical skills, they must tell the animal’s owner. When making a decision about whether to attend an emergency, a veterinarian should consider if they have received consent from the owner given their skills and any resource limitations. They should also consider if they can access support or advice from more experienced veterinarians.

The CAC commented that a veterinarian will not generally be able to give a definitive diagnosis in an emergency care consultation. In the first instance, the provision of emergency care veterinary services is about triage and pain management. Where appropriate, the veterinarian may also be able to advise on the diagnostic pathway.

In this case, the veterinarian explained the limitations of their companion animal experience and their ability to take and interpret radiographs to the client. The client still chose to proceed following this discussion.

Unfortunately, some parts of this case were complicated by the holiday period and having some more experienced companion animal colleagues on leave. The CAC was satisfied that the veterinarian had explained the limitations of their clinical skills and competence to the client, and the clinics resourcing. The CAC decided the veterinarian met the expected professional standards.

The client complained that repeat radiographs were not suggested. In their response to the CAC, the veterinarian said that they did not take repeat radiographs because in their experience, the orthopaedic veterinarian would likely want to perform these at the follow up appointment. While this uncertainty would have been distressing for the client, it is an unfortunate reality that there was a delay due to the holiday period. The CAC felt it was acceptable to defer taking repeat radiographs until the orthopaedic veterinarian could assess the case.

The reflections and insight shared by the veterinarian during the CAC process was also acknowledged. The veterinarian reviewed the case with a colleague, which included a discussion about correct radiographic technique, patient and limb positioning, radiographic views, and normal growth plates versus non-displaced growth plate fractures in young patients. The veterinarian also said they will now consider using teleradiology for a timely interpretation of radiographs.

The CAC felt that the veterinarian’s conduct met the minimum standard expected of a mixed animal veterinarian (who is predominantly seeing a production animal case load). The CAC decided no further action needed to be taken, and educative advice was provided.

The CAC noted that there were some wider learnings for the profession from this case, including veterinarians thinking about using teleradiology for cases that would benefit from further interpretation. The use of teleradiology can enable a more rapid and complete veterinary assessment, particularly if the case is outside of the veterinarian’s level of competence.

Veterinarians may find it useful to refer to the Vet Council Guidance on Telemedicine, which can be found on The Hub.