Case study: What happens when a veterinarian falls short of the expected standard?

these case studies demonstrate how complaints and other concerns are managed by the vet council, and what the profession can learn from them they are a regular feature of this pānui please let us know if there are any specific issues you would like us to cover background a 17 year old cat was taken to a vet clinic after its owner became concerned that it was not drinking water the attending veterinarian prescribed treatment for a suspected upper respiratory tract infection five days later, the cat was brought back in the client said it had been missing for the last two days and had not received any medication during that time the veterinarian said that based on their initial observations, the cat had tachypnoea and they were concerned about respiratory distress they did not perform a physical examination the veterinarian said the cat had a poor prognosis, and recommended blood testing, radiographs, and a referral to an emergency care after hours clinic (as it was the weekend) the other options were palliative care or euthanasia the client chose palliative care for the cat, who’s condition deteriorated the next day it was then euthanised at another veterinary clinic the complaint the cat’s owner made a complaint to the vet council and said that the veterinarian failed to communicate why further testing needed to be performed, and did not complete a clinical examination – which was why they declined the full diagnostic work up that was recommended the owner also complained about the standard of the veterinarian’s clinical record keeping the complaint was referred to the complaints assessment committee (cac) the cac is a preliminary screening body, which decides what should happen after a complaint has been made about a veterinarian the cac can conduct a formal investigation and decide what steps, if any, need to be taken to ensure a veterinarian is fit to practise and public interest is protected there was conflicting evidence presented to the complaints assessment committee (cac) about whether the cat was in respiratory distress at the time of the second consultation the client said that the veterinarian did not have a clear view of the cat during their assessment, and that they were leaning on the wall during the consultation reports about a further physical examination was also disputed the veterinarian said that they evaluated the cat’s body, muscle condition, and lymph nodes, and performed an oral examination, including the mucus membrane colour and capillary refill time the client said these examinations were not performed what professional standards are expected? the guiding principle of the veterinary services part of the code of professional conduct is that veterinarians must deliver evidence based veterinary services of a high standard, which are appropriate and meet the needs of their clients, and the welfare and health needs of the animals under their care they also must ensure their clients’ animals have access to emergency care competency standard 7 covers effective communication and includes indicators that veterinarians must provide clear and accurate explanations of findings, treatment options, and likely outcomes in easily understood language the client’s understanding of the information must be confirmed the code also requires veterinarians to keep clear and accurate clinical records the records must have enough detail so that another veterinarian could take over the management of the case at any time how it was managed when reviewing a complaint, the cac measures the veterinarian’s conduct against the standard expected of a veterinarian practising in similar circumstances, and refers to published professional standards the veterinarian in this case said that they elected not to performed a physical examination because the cat had undergone a full examination two days earlier they said that because the cat had the same clinical signs and symptoms, they did not want to place it under additional stress the cac noted that they would expect a veterinarian in similar circumstances to perform a physical examination of the patient and provide the client with the likely diagnosis (or a list of potential diagnoses) they would then discuss the different diagnostics or treatment options if the veterinarian believed an examination was risky and their preference was not to perform it, then this should be clearly communicated to the client so they can make an informed decision on how to proceed ideally, the decision about a proposed course of treatment is made in partnership between the veterinarian and the client the cac reviewed the veterinarian’s treatment plan and recommended diagnostic pathway ideally, a second examination should have been performed, as clinical signs can change within 48 hours a distance examination would have been appropriate however, based on the clinical records and both accounts before the cac, there were no animal welfare concerns that needed to be addressed exactly how clearly information about the potential treatment options was conveyed could not be determined the cac felt it was clear that the client did not understand the recommendations, the proposed diagnostic pathway, or the reasons why further testing might be needed there was no written confirmation of the client’s decision making through a consent form or the clinical records the cac was concerned about the standard of the clinical record keeping the records were brief and did not include any detail about baseline parameters, the treatment plan, or client communication the veterinarian said in their response that they were under significant time constraints the issues raised in the complaint came from a lack of communication, and while the veterinarian should have communicated the cat’s treatment options and the poor prognosis, this particular case did not reach the threshold for further action under the act decision the cac decided that the veterinarian had met the minimum expected standards of care, but the veterinarian’s communication was inadequate the cac issued specific and measurable recommendations to the veterinarian to be completed within six months no further action was required often, the cac’s recommendations require the veterinarian to complete a reflective piece of writing or to complete continuing professional development (cdp) the recommendations are followed up by the vet council the cac recommended that the veterinarian complete a unit of continuing professional development focusing on client communication, and provide evidence (e g the plan and a record of completing it) to vet council staff within six months engage with a senior veterinarian from their clinic to act as a mentor, and discuss client communication in cases involving chronic pain management, palliative care, and euthanasia at the end of the six months, the veterinarian must provide a reflective piece of writing outlining any changes to their approach and any learnings taken from the process