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Saturday, January 23, 2010

Whose Fault?

From Robbie...

I recently adopted a lardge bloodhound from the pound. He was too awesome a dog to get put down, and besides, my other bloodhound needed a playmate.Being from the pound, I was required to have him neutered. The procedure went well, but something did go wrong. His scrotum had swollen immensely, and so two days later they did an emergency surgery to remove it. Afterwards, the vet explained that the problem was one vein he had tied off wasn't tied tight enough and had filled the scrotum with blood. I know very well that mistakes happen, and I'm just glad the problem was resolved. However, this surgery drove the total cost up quite a bit. Times are tough and frankly, I can't afford it, but the vet is charging me full for both surgeries. I don't really see this as fair because the second surgery resulted from his mistake during the first. Do I have any options? Thank you. 

About 12 years ago my father collapsed in his bathroom and my mother called the paramedics. When he got to the hospital the doctors worried that he was having a heart attack and placed a catheter into his artery.  While doing so they accidentally tore a coronary vessel, causing him to bleed around his heart.  This required emergency open-chest surgery.  Thankfully, they fixed the problem and he's doing fine today.  And yes, the hospital charged a the full price for all procedures, including the surgery to correct their "mistake".  After he recovered, my mother was asked if she was planning on suing the hospital.  After all, it was their fault that he bled and almost died.  There was actually a good chance that she would win the suit.  However, my mother replied "Why should I sue?  They saved his life."

I really respected my mother for this decision.  I believe that far too many people sue in our society, and that people are simply not allowed to ever make mistakes.  My mother looked at the larger picture of the fact that the doctors had done everything they could and succeeded in saving my father.

Now back to Robbie's situation (yes, there was a point to my little story).  I have had dogs that I neutered develop a scrotal hematoma, similar to what Robbie describes.  All of them developed a swollen, bruised scrotum, though they did not require surgery.  Most cases like this will eventually reabsorb and resolve without further surgery, though the dog may be more uncomfortable than normally happens post-op.  In all of these cases I performed the surgery within acceptable standards and to the best of my ability.  If a suture wasn't tight enough or had slipped off, it wasn't due to neglect or inability on my part.  So even though this complication happened after I performed the surgery, I don't know that it was due to my "mistake".  Unfortunately, nobody can be perfect, even doctors.  There will be times that a doctor does everything correctly, but something still goes wrong.

Robbie, the vet does have a right to charge for both procedures.  They also have a right to waive any fees.  When I made my mistake (which you responded to) I chose to avoid charging for the second surgery, though I did not refund any fees for the first one. However, in that particular case I had accidentally created a life-threatening condition, though it was a once in a career situation.  Your case has happened to almost every vet out there, and is not life-threatening.  Was a second surgery even necessary?  I can't say, as I didn't see your pet, and I can see justification for and against a second procedure.

There are a couple of ways you can choose to act.  Because there is a chance that the vet did not perform the surgery adequately, you could consider a lawsuit.  However, I think it would be a tough case to win, as you would have to prove malpractice or neglect.  A slipped suture causing a non-life-threatening condition is a potential risk of a surgery.  However, I'm not a lawyer so I can't say for certain if it's a valid suit.  Or, you could take an attitude like my mother did and realize that the vet did help your dog, and had to use his time, equipment, and materials and it is fair for him to be reimbursed.  In the end, the decision has to be yours.

10 comments:

  1. wow.. i really think that your mother is awesome =D

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  2. Dr. Bern: Is it really a fair comparison?

    One was a life-threatening emergency and the other a scheduled and considered routine procedure where time is available to check all sutures thoroughly and correct any mistakes.

    Your comparison was better of the same issue & perhaps a second surgery may have not been needed nor charged for?

    Regardless, you handled the mistake with kindness & honesty.

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  3. Actually, I do think it is a valid comparison. In both situations the something happened that could have been attributed to a mistake by the doctor. With Robbie's dog, this was not a life-threatening situation. My father could have died from the "mistake". In both cases the doctor was doing his/her best and had no intention of committing an error.

    Also, situations like Robbie's dog may not be immediately obvious. I always check for "bleeders" before I close an incision, and yet I have had scrotal hematomas occur. In all of these cases I never saw any evidence of significant bleeding during the surgery, and the suture must have loosened or slipped postoperatively. Sometimes things like this happen even with the doctor doing everything correctly.

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  4. Barbara A. AlbrightJanuary 25, 2010 at 7:41 PM

    Ok, Dr, Bern: (only because I think you are a nice guy), I have a true story and a hypothetical:

    (true) My Mom goes to a recent Dartmouth graduate that is a pulmonary specialist. She has excess pleural fluid in one lung sac and can hardly breathe from the pressure. He does a pleurocentesis (spelling ?) and punctures the lung causing emergency pneumothorax requiring ICU hospitalization. Ok, everyone can make a boo boo, right? Well, he tells my Mom & Dad that cancer is unlikely because the pathology report is not definitive & cortisone seems to be a symptomatic cure.

    However, weaned off the cortisone, the fluid once again builds up requiring another "lung tap". Once again, during the tap another pneumothorax occurs, sending Mom again to ICU. Finally, daughters (me included) can't take this idea of risk and possible misdiagnosis anymore (a year has elapsed) and insist Mom go to Boston. Mom is diagnosed with "cancer"---no question. It is also stage 111B.

    (previous pulmonary specialist closes up practice and moves to mid-west).

    Does Mom, age 69 & Dad want to sue for delayed diagnosis? No.

    (hypothetical):

    Daughter Barbara, age 50 goes for laparoscopic "tube tie" earlier at age 40 for permanent pregnancy prevention. Daughter, after a few days, has a fluid-filled abdomen & peritonitis. And needs hospitalization, drains, antibiotics , and possible corrective surgery. Should Barbara sue or just shrug and say, oh well...mistakes happen, whats another $20,000 or so and an extra 2 months out of work?

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  5. Great post, I honestly think that if the American people wasn't so sue happy we might not be in the shape we are in today.
    A famous sports doctor botched my dads first leg operation, we didn't sue.

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  6. Oh, so cool TC, what on earth are you doing here? After I read your kind blog about murdering "runt" pig in- humanely?

    Ugghhh, It takes all kinds.

    What famous sports surgeon in YOUR neck of the woods, pray tell??!!

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  7. Barbara, the problem with many people is that they expect every medical procedure to be perfect. That simply can't happen. Sometimes biopsies don't get the answers you want. Sometimes a procedure has unforseen complications. Some procedures carry known risks, even if they're rare. Medicine can't be perfect, and if things don't happen exactly as we plan on them, it doesn't mean that someone did something "wrong".

    In the case of your mother, a normal biopsy on the first try doesn't mean that the doctor intentionally missed something. When you take a biopsy, you might miss the lesion depending on how large the problem is. Biopsies aren't fool-proof. Ask any surgeon and oncologist and they'll tell you that sometimes we simply don't get good samples.

    Now if someone is truly incompetent or performs actual malpractice, they should be persecuted to the full extend of the law. But not every case of complications means incompetence and malpractice. Any medical procedure has risks and complications.

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  8. Dr. Bern: I can understand a "non-committal" answer, I really can. The problem with vet-med is that the profession has slipped under the wire for so long, that it has allowed everything & anything.

    The "true" story was to illustrate not one but TWO procedures in a row that went badly. My Mom had the same procedure done several times more by a more-skilled doctor with nary an issue. The other illustration was that my parents did not RUN to an attorney, though both times cost un-necessary medicare costs (in ICU, no less)

    The biopsy? Well it was inconclusive and could have been "interpreted" either way. Us, as family members became concerned that it was not "suggested" to repeat, NOR confirmatory tests done. Did it make a difference in that year? Probably not.

    Ok, the second is a hypothetical--- a routine procedure by a trained specialist--that went horribly wrong, would you sue?

    The answer is without a doubt---the person HAS the right, NOR would it be frivolous (lost work, suffering, extra medical bills--)

    So the question was "should the client have paid for a surgical repair to a complication to a commonly considered "routine" procedure?

    I hope I illustrated that most likely the answer should be NO!

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  9. One thing no one has mentioned yet is consents, I am a HUC in an orthopedic surgical floor and surgical consents ARE VERY DETAILED IN ALL THE COMPLICATIONS THAT CAN OCCUR. I feel that since the patient has signed that consent, they cannot possibly expect a surgery to go without complications, nor can they sue for something that is not out of the question as a possible result of a procedure.

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  10. I'm a contractor. If I install a dishwasher and don't get the waterlines tight enough and the appliance leaks, causing water damage to the floor and cabinets, do you think it's fair that I charge to come back and make it right? After all, I didn't intentionally do it. Mistakes happen. I'm not perfect.
    Your argument is what one would expect; defending a fellow vet. I disagree, wholeheartedly. If you, as a vet, can't be sure you did it right, you shouldn't be doing it.

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