Communicate first, discipline second

As various associations adopt guidelines or standards of care for the practice of veterinary medicine, a concern exists that they will be interpreted as current standards of practice by state regulatory boards and the attorneys general who represent them before they have been accepted by the masses.

I find too often that the word of an authority regarding what constitutes standards of care for a procedure is an inaccurate guess. As a practitioner for 16 years and an expert witness for 20 years, I know that standards of care evolve with time.

What is taught in veterinary school today and at major continuing education meetings often does not become the standard in the majority private practices for up to 10 years. As it does, 25 percent to 40 percent of practices initially will jump on the bandwagon. The application of these new standards to everyday care might vary modestly, even within one practice. With time, roughly half of all practices will join the movement. After a few more years, that number might creep up to 80 percent. Some will never join in because they are skeptics, laggards or insufficiently educated to understand the science or human-animal bond behind the changing standards.

Without accurate surveys of private practices or secondary-care centers, expert witnesses usually are guessing about the percentages of practices that do things one way versus another. The only way I can keep abreast of it is to use the unscientific method of querying audience members during my speaking engagements. I ask a question such as whether practitioners now centrifuge their fecal flotations. I then interpret audience responses as indicative but not definitive for a current standard.

With no statistically relevant polling on how most DVMs practice, emerging care standards have become highly problematic for licensees. Too often, regulatory-board officials err if they fail to alert licensees when consumer complaints surge on topics such as pain management or complications from non-steroidal anti-inflammatory drugs due to lack of client education. But no matter what the issue, the biggest problems are:

1. The absence of surveys substantiating standards of care and how those definitions should differ in secondary-and tertiary-care facilities compared to primary-care practice.

2. Expecting licensees to keep up with changing standards gleaned from continuing education and communication with their colleagues or risk disciplinary action as soon as more than 50 percent of licensees adopt the newest standards of practice. The multi-year change from annual to triennial vaccinations and administration of pre-emptive and post surgical pain-management drugs for all orthopedic and body-cavity procedures are examples of changes that have occurred in the past decade.

So when a mere 51 percent to 60 percent of licensees comply with the alleged existing or new standards, it means that the other 40 percent to 49 percent of practitioners could be disciplined for failure to meet the new protocols. That is scary.

My experience as a veterinary licensee in two states is that most regulatory boards fail to communicate effectively with licensees on a regular basis. When they do, they put them on notice that client complaints have risen and disciplinary actions will be pursued with more vigor.

However, when boards believe that practice standards for procedures have changed in areas such as vaccinations, pain management, or instructions about adverse drug side effects, they need to place all licensees on notice prior to disciplining them.

An example of this occurred in a recent Minnesota case involving allegations that a rural practitioner failed to meet the standards of care for the administration of pain-management drugs.

He did not know that this had become a hot issue for the board, which did not disseminate any references on the subject and then tried to claim that the standards were the same for private practitioners in rural Minnesota as for a veterinary teaching hospital.

I am appreciative of the massive amount of volunteer time that veterinarians and public members donate to their state's regulatory efforts to protect consumers from substandard veterinary care. Yet I worry that licensees are placed at a treacherous disadvantage when boards unleash disciplinary action based on vague or emerging standards of care with no appropriate notice.

My hope is that when veterinarians' licenses are at stake, state regulators will prepare their licensees to adjust to these emerging standards before they take aggressive disciplinary action.

James F. Wilson

James F. Wilson, DVM, JD, is owner of Priority Veterinary Management Consultants in Yardley, Pa. He can be reached at (215) 321-9488 or jwilson@pvmc.net