Remove malpractice risk from anesthetic risk

My office frequently receives calls from the general public after visiting my Web site.

More often than not, such calls are requests for advice or referral to plaintiff's attorneys who might be able to help disgruntled clients pursue a malpractice case against their veterinarian.

Of such calls, a disproportionate number involve pet deaths that have occurred while an animal was sedated or under anesthesia. Many also involve anesthesia-related deaths that have occurred shortly after completion of the procedure for which the animal was put under.

Although I rarely become involved in plaintiff's work, I frequently speak with such callers. I have learned a great deal about distressed clients and what they are looking for from us as veterinary practitioners when an anesthetic-related problem crops up.

Key points

There are a number of key points involved in avoiding and managing accusations of wrongdoing related to sedation and anesthesia.

As is the case with avoiding problems with forming a partnership or buying a practice, the most useful steps are those that can and should be taken before the event occurs. What does this involve?

Anesthesia is, by its nature, an inherently risky undertaking. Think of it as you would about walking through a slippery parking lot. Before you leave the house, you put on your shoes or boots that have the best traction. In other words, every possible step should be taken to minimize risk. This applies to your surgery suite.

Do you have a plan to instantly address a respiratory or cardiac crisis? Does your technician or assistant know that plan? Does everybody know the precise location of the drugs you would need as well as their dose and route of administration?

When the malpractice deposition comes along, you will want to be able to answer these questions affirmatively and with confidence.

Let's extend our analogy: If it's icy and slippery, you don't go on an errand at all unless there is a good reason to do so. It really pays to think twice before undertaking something dangerous. Can the problem be handled other than with a procedure involving anesthesia? Would sedation suffice rather than a general? Is the anesthetic risk great enough that a referral to a veterinary school teaching hospital or multiple-specialty referral center should be offered?

No surprises

With this analogy in mind to help guide us prior to the surgery, what can we do to keep a client suing us after her pet dies during or after a procedure? Your best protection is to do everything possible to avoid surprising the client.

Disappointed clients rarely sue veterinarians. Neither do sad clients. Clients who sue are shocked clients; they sue after they bring in a reasonably healthy looking pet but leave with their animal in a plastic bag. They sue when their high-risk pet dies under anesthesia and no one fully explained the concept of anesthetic risk.

The good news is your practice can use this reality to couple malpractice avoidance with practice-building. Consider taking these steps:

• Do not cut without a blood panel or a signature. When recommending surgery in the case of a dog or cat more than a few years old, strongly recommend a full pre-surgical blood screen. If the blood screen is declined, get the client to waive it in writing. A pre-printed form for this purpose is simple to prepare and worth its weight in gold during malpractice litigation. Liability-wise, you are almost better off with a waiver than a clean panel in your record. A waiver could be considered tantamount to intervening owner malpractice.

• Remind clients that anesthesia is never routine. Whether or not pre-anesthetic blood work is performed, explain the general nature of the anesthetic protocol and describe even the remote risks. The goal is not to scare clients or deter them from having the procedure performed. Rather, a serious discussion of risk makes it clear that you consider what their pet is about to undergo just as important as the client does. The conversation will also help distinguish you from any previous veterinarian with whom a client has had a bad surgery experience.

• If you've got it, flaunt it. If your practice has modern anesthesia and anesthetic monitoring equipment, let the client know. Analogize what occurs in your surgery suite to what is done in the human surgical arena. Explain that while all anesthetics carry risks, "these are the things we do here in order to reduce that risk..." On the other hand, if there are things going on in your surgery suite that you are not proud to mention to clients, you know what you need to do.

• Think hard before you go out during a winter storm warning. There are times when the risk of surgery is so significant you need to force the client to bear the risk. When that ancient Poodle comes in with multiple gross skin tumors and halitosis from a million bad teeth, the question presents itself: Is putting this otherwise decently healthy dog under anesthetic something I really want to do? Tell the owner, in detail, all the risks of leaving well enough alone and the risks of taking the patient to the operating room. Don't tell your client what you would do if it was your dog; that's irrelevant, and there are simply too many unknowns. Whatever the client decides, place the detail of the discussion in the medical record.

And don't forget to charge the client an extended office visit for the time you took giving your professional risk evaluation.