A ten-month-old cat was taken to a veterinary clinic for an emergency appointment after its owners noticed it was having trouble breathing and was wheezing. The symptoms had started about an hour before the consultation.

The veterinarian examined the cat and performed thoracic auscultation. They noted crackles and wheezes on auscultation, signs of pain when the thoracic area was lifted or held, and abdominal discomfort on palpation. There were no signs of trauma, a cat bite or bruising. The veterinarian discussed these findings with the client and the presumptive diagnoses that the cat may have a pleural effusion or pneumothorax.

The veterinarian recommended thoracic radiographs to help inform a diagnosis, which the client declined because of the cost, and asked for medication instead. The veterinarian explained that radiographs were needed to reach a diagnosis and were a necessary step before prescribing medication. The client again asked for medication and suggested they could come back if the cat’s symptoms got worse. The veterinarian advised this was not their preferred approach. After some more time to consider the recommendation, the client consented to the radiographs and left the clinic.

Radiographs (left lateral, right lateral, and ventrodorsal views) showed a pneumothorax (pleural gas). The veterinarian sent the images for specialist interpretation. After discussing the findings with the lead veterinarian, the veterinarian performed thoracocentesis. The cat was placed on oxygen and sedated, and 81.9ml of air was drained. A repeat lateral radiograph showed the pneumothorax had reduced, and the veterinarian said the cat appeared stable and was breathing normally.

The cat was discharged that evening. The veterinarian said they explained that the radiograph findings were not clear, and that a spontaneous pneumothorax could be caused by a tear in the trachea or a lung infection and could return. They recommended cage confinement and a review the next day, including repeat radiographs (as recommended in the specialist report) and repeat thoracocentesis. A Metacam injection was given, and oral Metacam was prescribed.

The client said that once home, the cat’s movement was limited and it had trouble breathing. During the night, it was still struggling to breathe, and the client said its neck became swollen. The cat later passed away.

The client made a complaint to the Vet Council, which was referred 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 client complained that the veterinarian took a conservative approach to treatment. They believed the cat should have been hospitalised on oxygen therapy until its breathing stabilised. They also complained that the veterinarian did not communicate the severity of the cat’s condition, the risks involved, or why radiographs were necessary, and did not give adequate information about aftercare.

The client said the veterinarian did not offer other treatment options, such as a referral to a dedicated after-hours clinic or contacting the clinic if the cat’s condition worsened. They also believed the veterinarian had tailored the discussion and withheld information based on assumptions about their finances.

The Code of Professional Conduct sets out the professional standards that the Council, the profession, and the public expect veterinarians to meet and comply with. The competency standards set out the competencies expected at registration and on an ongoing basis, and provide the criteria against which an individual veterinarian’s performance may be measured.

The veterinary services part of the Code requires veterinarians to deliver evidence-based services of a high standard that meet the needs of their clients, and the welfare and health care needs of the animals in their care.

The Client Relationships part of the Code requires veterinarians to obtain a client’s informed consent before proceeding with a proposed treatment or course of action. This includes making sure clients are given enough information in a way that they can understand so they can make an informed choice about treatment options.

The CAC considered the veterinarian’s conduct against the standard reasonably expected of a veterinarian practising in similar circumstances, with reference to the Code and the competency standards.

The CAC considered that the veterinarian’s approach exceeded the expected standard. Thoracic radiographs are the most appropriate diagnostic tool for pneumothorax and were a necessary step before any medication was prescribed. Thoracocentesis was the next indicated step. The CAC also acknowledged that the veterinarian discussed their approach with the lead veterinarian, who endorsed it.

In their response to the CAC, the veterinarian acknowledged that they did not give the client the option of taking the cat to an after-hours clinic. They said they had wrongly assumed the client would call the clinic if the cat deteriorated, and that the client was already aware of after-hours options. The veterinarian also acknowledged that they should not have let cost considerations influence the treatment options they presented.

The CAC felt that the decision to discharge the cat for at-home monitoring was appropriate, although conservative. The CAC considered that it was appropriate to discharge the patient because it appeared to be in a stable condition. It was noted that the clinic provided overnight patient monitoring.

However, the CAC felt it would have been ideal for the veterinarian to offer the option of a referral to an after-hours emergency clinic. This would have given the client the full spectrum of options and allowed them to make an informed decision about next steps. The CAC did not think that this reflected adversely on the veterinarian’s fitness to practise, but noted it was something to consider in the future.

It appeared that the owners were not aware of the spontaneous nature of pneumothorax or the possibility that the cat could deteriorate. Veterinarians are expected to communicate how serious a patient’s condition is and reinforce the need for monitoring and further care. While the seriousness of the cat’s condition could have been conveyed more clearly, the CAC considered that the veterinarian’s communication met the minimum standard during what was a challenging situation.

The CAC determined that the veterinarian conducted themselves appropriately and demonstrated a high level of competency, particularly given the uncommon nature of pneumothorax. Regarding the diagnostic pathway, radiographs were the most appropriate first step in reaching a diagnosis. The CAC commended the veterinarian for their thorough approach to a complex clinical presentation, taking place in an emergency care setting.

The concerns raised did not reach the threshold for further action under the Act, and no further action was required.

The CAC noted that in cases involving a presumptive diagnosis of pneumothorax, clients should be offered the option of referral to an after-hours clinic for further treatment and ongoing monitoring.

When a patient is discharged with a serious or potentially unstable condition, clients need to understand how significant it is, that it may recur or deteriorate, and what to do if that happens. Veterinarians should not assume that clients already know about after-hours services.

Assumptions about a client’s ability to pay should not shape which options are presented. Offering the full spectrum of care, including options a client may be expected to decline, allows the client to make their own informed decision.

Our complaints process serves as an important tool to uphold the standards vets must meet, to protect animals and people, and to maintain trust in the profession.

The CAC is an independent committee of the Council. It consists of two veterinarians and one lay person. The CAC functions as a preliminary investigatory body, which decides what should happen next with a complaint.

The CAC process is centred around the veterinarian and reviews whether they have met the standards in terms of professional competence and conduct. The CAC will often investigate before reaching a decision. The standard applied by the committee is whether the veterinarian acted as would reasonably be expected of a competent veterinarian practising in similar circumstances.

Our objective is to use a fair and transparent process to support high standards of veterinary practice and safe, well-functioning practice environments. The committee applies regulatory principles to its decision-making, meaning that any response is proportionate to the level of risk involved. Where appropriate, we use education and recommendations to support changes to practice.