Veterinary malpractice accusation: Diagnose the causes

After graduating, veterinarians find they face a demanding professional standard of care. The last thing any young doctor wants to do is forget some important piece of medical minutia learned in the classroom and, as a result, cause a patient to fail to improve (or worse). In an attempt to overcome the inevitable lack of confidence that accompanies inexperience, new graduates often harbor fears that some inadvertent oversight will result in a lawsuit, license suspension or firing. The threat of malpractice seems to lurk behind every decision.

As an experienced attorney and the former employer of scores of recent veterinary graduates, I can tell you that most malpractice allegations against young doctors result from just a few practitioner behaviors. Becoming aware of these actions — or lack or action — can help you avoid potential problems on the legal front.

Handle your "high maintenance" clients with care

Some malpractice claims arise through no error in medical or surgical skill on the part of the veterinarian. Seasoned practitioners can attest to the fact that every practice has a small but vocal percentage of regular, long-standing clients who are "high maintenance." That is, they want to be seen at times convenient for them, tended to just as promptly as they insist and "loved" as if they were the only clients in the world. In the event of an unfortunate outcome, often such a client will bring a claim against a new doctor for perceived inappropriate diagnosis or treatment merely because the client is unhappy with the way the new graduate spoke to or treated him or her.

Maybe she didn't like the new doctor's personality or felt insulted that the practice owner "dumped" his best client (her) onto some kid who doesn't know anything. Maybe she wasn't treated like royalty or maybe the young practitioner actually had the gall to suggest that her pet was too fat, too spoiled, too fractious, not perfect breed quality or some other intolerable statement.

To avoid these claims, the practice owner should attend the new graduate's first appointment with such a client. This gives the prima donna client the feeling that there is still a seasoned captain controlling Fluffy's ship; even though he may not be in the wheelhouse, he is not far away and has confidence in the second-in-command he has left in charge.

Of course, not all malpractice claims are unwarranted. Of malpractice and state board claims that arise because of medical error, many are attributed to a veterinarian's failure to act. In my conversations with other lawyers and state board members, I have learned of numerous complaints against new doctors that arose from inaction rather than a mistake as it relates to the care of a patient.

Follow up on deteriorating medical cases

It is human nature to avoid uncomfortable situations. Unfortunately, denial can get us into trouble in this profession. While it is not pleasant to talk to a client whose pet is getting worse or is not improving, it can be a serious mistake not to get in touch with these people right away.

First, if the doctor waits too long to return a client phone call, he or she may appear uncaring or inattentive. Second, if that doctor-imposed delay involves a wait until the end of the workday, the client may decide the cost of an emergency appointment is out of reach, leaving the problem to get much worse overnight.

Accept that offering proper care isn't always convenient

Hoping that a condition will remain stable or improve without actually examining the patient is risky business. This one is a biggie and frequently unfolds like this: A client whose dog or cat has been vomiting, bleeding or acting profoundly lethargic for several days calls at 4 p.m. on Friday, suddenly concerned. Young Dr. Newbie has had a heck of a week and plans to go out dancing when her shift ends at 5 p.m. The afternoon hour remaining is already full of appointments.

Newbie takes the call and no matter how disturbing the client's description of the symptoms, she mentally adjusts that description into a set of signs that "almost certainly will respond to OTC medication, rest and force feeding ..." Newbie's creatively optimistic interpretation eliminates the need for an immediate appointment (which would be hugely inconvenient).

This sort of "hope and pray" medical management is a common route to malpractice court. Most of the time, these cases can wait until tomorrow. The smart money is on not taking the risk.

Dr. Newbie needs to remember that there are other ways to handle this type of call. If the practice is too busy to handle the case, she could direct the client to another private practice. The boss might be upset when he finds out, but surely that beats a malpractice claim featuring a dead patient.

Dr. Newbie also could refer the client to an emergency clinic or university hospital. The inconvenience and/or extra expense might annoy the client, but, again, either or both are preferable to a call from the state veterinary board.

Of course, Dr. Newbie could just suck it up and see the appointment, remembering that health professionals have never been promised convenient 9-to-5 careers.

Do your best — it's better than doing nothing

Considering all of the medical facts a new graduate learns over four years of veterinary school, it's hard not to be afraid that you might forget or overlook some critical detail of a procedure. However, malpractice claims against inexperienced veterinarians are most common when the doctor should have performed an emergency procedure, such as thoracocentesis or removal of a foreign body, but did not. Malpractice claims are far less common against a doctor who does perform such a procedure but it doesn't turn out well.

There are two key points to remember about emergency intervention. First, as a new graduate, you should take advantage of every available opportunity to practice critical procedures. If you can, ask that the practice owner or mentor allow you to do such procedures yourself when an in-hospital patient requires it. This way, when you're on call or working solo, you'll be more familiar with emergency techniques.

Second, even if you are still an inexperienced doctor, you need to summon the courage to handle an urgent situation. If time is critical and there is no experienced help available, you will need to perform the required critical procedure — even if you're worried about your ability to do so successfully.

While a bad outcome may later result in an inquiry as to whether the doctor performed the intervention competently, there is no question that when action is required, failure to act shows incompetence.

Dr. Allen is president of the Associates in Veterinary Law P.C., which provides legal and consulting services to veterinarians. Call (607) 754-1510 or visit info@veterinarylaw.com.