A referred pain: Board inquiry comes back to bite this veterinarian

(Shutterstock)Dr. Lucas is truly an old timer. He has had a solo practice in a small community for 53 years. He is beloved by his clientele, some of whom are the grandchildren of pet owners he assisted decades ago. He often answers his own clinic phone, begrudgingly uses his computer, and hand-writes his medical records. He is an excellent diagnostician, and at age 81 is still an officer in the local veterinary association.

Dr. Lucas was recently examining Mrs. Hall's dog Gretel when he noticed a soft walnut-sized mass on the dog's back. Mrs. Hall told him the lump had been present for about three weeks but did not seem to bother Gretel. It did, however, bother Dr. Lucas. He took a fine-needle aspiration sample from the growth and sent it to the lab. The results showed mast cells. At this point Dr. Lucas told Mrs. Hall that she and Gretel would have to visit the oncologist. He assisted her in making an appointment at the large specialty center located about five miles away.

The oncologist examined Gretel and determined that a wide excisional biopsy should be done. The surgery was initially uneventful, but five days after surgery the wound broke down and the dog had to be readmitted for further surgery. The biopsy did reveal a grade 2 mast cell tumor. After the second surgery the dog did well, but the owners did not. They believed the wound breakdown was the result of a surgical site contamination. They thought more diligence on the surgeon's part could have prevented this complication. They demanded a refund for the second surgery.

The surgery center representative explained that complications can occur. She said the event was unfortunate but was ultimately able to be resolved. The specialty center did not believe that it was required to return any money for the second procedure. The owners disagreed and filed a negligence complaint with the state board of veterinary medical examiners.

As is standard with a complaint of this nature, the state board requested the medical records of all veterinarians who treated the pet. As a result, both the surgical center and Dr. Lucas were required to present their records. The board reviewed the surgical center records and its response to the client. It determined that the hospital had performed within the standard of care and found no cause for sanctions.

But during the board's review of Dr. Lucas' records, it found several record-keeping violations. His non-computer-generated records did not include some of the entries required by the state practice act. The doctor's name was not on each medical record page nor were there any medical conclusions in the medical narrative. The board dismissed the complaint against the surgical center yet found Dr. Lucas guilty of multiple medical records violations. This sanction carries a penalty and a notification placed in a public database.

Needless to say Dr. Lucas was furious. The pet owner had not even filed a complaint against him. He contacted his professional liability carrier and notified the board that he was requesting a hearing. At the hearing Dr. Lucas stated that he was a diligent practitioner with a flawless record. He also said that this particular record shortcoming came on a hectic day and was not representative of his overall record-keeping. In addition, he took the board to task on a procedural detail. As a rule, board sanctions are triggered in response to pet owner complaints. The board does not randomly select practitioner records to see if they meet practice act standards. In this case there was no complaint lodged against him. As a result, the board violated its own standard procedures. He concluded by requesting that the board vacate its medical record-keeping violation against him.

What do you think the board's decision should have been in this case?

Rosenberg's response

The first thing to understand is that state boards are consumer advocates. In most states they fall under the auspices of the division of consumer affairs, and if a board detects a practice act violation, it cannot turn a blind eye.

That being said, Dr. Lucas has a valid objection and state boards do have the option to use discretion. Dr. Lucas is a long-time practitioner with a flawless record. While it's true that the board noted a deficiency, on balance the consumer was not damaged. In my opinion, overlooking a board sanction would be the proper discretionary action in this case.

The overall lesson here? It's always a good idea to make sure you're keeping complete medical records.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, New Jersey. Although many of his scenarios in "The Dilemma" are based on real-life events, the veterinary practices, doctors and employees described are fictional.