Translate This Blog

Thursday, August 8, 2013

When Bad Vets Cause Major Problems

Ready for a long one?  No names are used as this will likely end up in a lawsuit.

I'm usually quick to defend my colleagues and point out that veterinarians are human and make mistakes.  I've even posted some of my mistakes on this blog, and they are certainly only part of them.  But as in any profession there are absolutely vets who simply shouldn't be allowed to work anymore.  Recently I ran into a situation regarding one of these doctors.

The client came to me last week, having brought in her young male boxer for an exam.  I had seen him previously for a minor issue when her regular vet was closed, and she had liked me so she wanted a second opinion.  The boxer was very sweet, but had lost weight since I had seen him a few months ago, and had an obviously distended abdomen.  The owner had brought him to me because at a vaccine clinic a vet had said that the fluid in the abdomen needed to be checked, so this was my main focus.  On the exam he was bright and alert, and at home had been eating well, drinking normally, and having good bowel movements.  In fact, he had been acting normally and would have seemed healthy other than the slow increase in the size of his belly over a couple of months.  With him being a boxer my first thought was heart disease, as this breed is prone to cardiomyopathy.  I also ran through  a few other possibilities, such as low blood proteins and liver disorders.  I recommended x-rays and blood tests, whether they were done with me or her regular vet.  She took the estimate home and was going to consult with her vet.

Yesterday she dropped off a copy of the x-rays because she wanted another opinion.  And this is where the story gets more interesting.  Apparently the dog had had a problem this past December (2012) and x-rays were taken.  According to the owner the vet had said he had a wire in his intestinal tract and gave him some oil to help it pass.  When I looked at the x-rays, I noticed a couple of things.  First, the image only had the upper (dorsal) half of the abdomen.  The bottom half was completely out of the view and hadn't been taken.  His body was rotated, so it wasn't a straight-on side view like we're supposed to take.  And then I noticed the metallic thread or wire in the abdomen, inside some kind of cyst or mass.  It was a very poorly positioned image and one that any of my radiology professors would have flunked me for.  And despite that "wire", the vet never did follow-up with the clients.

A slight aside.....This isn't directly relevant to the case, but talks strongly about the quality of vet they had.  There were a few dozen x-rays of different pets on the disc the owners brought to me.  Initially I didn't know which one was the boxer's, so I looked through all of them.  I repeatedly saw human hands and arms in the image, holding the pets.  This is a HUGE workplace safety violation, and a major problem.  The humans whose hands were in the field of the x-ray were getting repeated doses of radiation, and the owner of that practice is responsible for any damage or cancer risks.  X-rays are safe when done in small doses, but repeated frequent doses can be a health risk.  My jaw dropped a little when I saw so many repeated major violations of basic radiation safety.

Besides the disc from over seven months ago, the vet did x-rays two days ago and the owner gave me a copy of that.  This one was much better positioning, but the object from December was still in the exact same place.  What was more worrying was that there was almost nothing normal about how the abdomen looked.  In fact, I had a hard time making heads or tails of what I was seeing, other than displaced organs and this large mass with metallic thread in the center.  Her other vet had told her that the dog had swallowed something that was stuck in the intestines and needed surgery.  

Let's take a slight digression for those not in the veterinary field.  When a dog has an obstruction in the intestinal tract it is going to cause serious issues.  The dog typically will stop eating, likely will vomit, and won't be producing any feces.  This is something that develops obvious symptoms quickly.  Yet this boxer had none of these symptoms and was eating and defecating normally.  The lack of GI symptoms combined with the fact that the object was the same over a nearly eight month period made me significantly doubt this analysis.  

Back to our story....the client didn't completely trust what the other vet was telling her.  She had dropped her dog off for the x-rays, and then called later in the afternoon.  The vet answered the phone himself, but when she identified herself he put her on hold and had one of his assistants pick up the phone and talk to her.  When she came to pick up her dog the vet was at the front desk and as she walked in he went to the back of the clinic.  At no point did she get to talk directly to him about the situation, and in fact it seemed like he was deliberately avoiding her.  With that feeling she wanted my opinion on the x-rays.

I studied the images, trying to piece together what could have caused this particular problem and appearance.  Then a thought occurred to me.  I asked her if by chance he had ever had an abdominal surgery in the past.  She said that when he was a puppy he was cryptorchid (a retained testicle) and had surgery to remove it.  That strengthened my suspicions.  Many kinds of surgical sponges have a metallic thread woven into them so that if they accidentally get left in the abdomen they can be easily noticed on an x-ray.  My fear was that during the abdominal cryptorchid surgery a sponge or gauze had been left in the belly, which would explain all of the problems.  

To shorten the story just a little bit (yeah, I know...too late) I referred her to a local surgical specialty practice because if my suspicions were correct I knew it was going to be a bigger problem than I felt qualified to handle.  They went today and I talked to the surgeon this afternoon.  He said that the surgery was long and difficult, and the abdomen was "a hot mess" (direct quote).  The large mass was obvious, with lots of abdominal tissue around it and multiple adhesions within the abdomen.  About six inches of intestine had to be removed, even though the mass was outside of the GI tract.  And what was in the mass?  A surgical laparotomy sponge, obviously left in after the original surgery.  

The owners are obviously livid about this situation, and I can't blame them.  I had told them that if it turned out to be a sponge it was the liability and fault of the veterinarian who performed the surgery.  In this situation they have an open-and-shut lawsuit and I'm sure they will pursue this option.  One of the things that made me upset was the denial or evasiveness of this vet.  If I suspected a surgical sponge without first knowing there was an abdominal surgery, surely the vet who actually did the surgery and used those sponges would come to the conclusion more quickly.  If I had made this mistake I would have admitted it and faced the consequences.  Don't believe me?  I actually blogged about one of my mistakes back in 2009, and was very open with the clients.  In this current case it seemed like the vet was deliberately avoiding the client.

Now it gets really bad....This afternoon after I spoke with the specialist I was talking about the case with a couple of my staff who had overheard my side of the discussion.  One of them is very experienced and has been in our area for a long time, even having worked for a few different vets.  She really knows the veterinarians in the local region.  She asked me what vet had done the cryptorchid surgery.  I was trying to remember but was having trouble, when she asked if it was "So-and-So" clinic.  I recognized the name and told her that was right.  She became immediately upset because she was able to guess the specific doctor and office.  Apparently this isn't the first time this doctor has left behind surgical sponges in patients.  She told me that she knows that he has been sued several times in the past for the same kind of thing, one time leaving six gauze pads in a dog during a routine spay.  According to her he has had to change the name of his clinic several times because of these lawsuits.

Frankly, if all of that is true I don't know why his license hasn't been taken away or why any company would grant him malpractice insurance.  But if he pays out of pocket and doesn't report it to insurance, they might not know.  And if the client only sues and doesn't report it to the state veterinary board then no action is taken towards license revocation.  

We all make mistakes.  I've been open about mine.  But I can be confident that I learn from my mistakes and don't make the same one twice (at least in my job....my wife might disagree about repeating mistakes in my home life).  But someone who repeatedly makes the same mistakes shouldn't be working in that profession any more.  As I said at the beginning of this blog, I'm quick to defend other veterinarians and give them the benefit of the doubt.  I never directly bad-mouth another vet just because I have a different opinion on a case.  But I also don't want to ignore true malpractice, and will strongly encourage these clients to look into options for a lawsuit as well as recommend that they contact the state board.

What about the dog?  He had major surgery that even a specialist had a hard time with.  There was also evidence of possible infection within his abdomen.  So he isn't out of the woods yet.  Though the surgery went as well as expected and the surgeon is hopeful, we won't know his short-term prognosis for at least another day or two, and then it will be another week after that before we can start seeing that he may fully recover.  If things go well he can likely end up living a normal life.  I'll certainly be praying for him and will follow-up with the client.

13 comments:

  1. Dr. Bern,

    I appreciate your candor, honesty, and "holier than thou" opinion, but I would strongly encourage you to understand that your side of the story and the side your client provides you are just one side.

    I would also encourage you that if you feel so compelled to provide advice in the form of available avenues of retribution to your client that perhaps you should be completely honest and pick up the phone and call the veterinarian you are setting up.

    I have been on both ends, and I know that my clients, likely with the best of intentions and the sincerest amount of concern do not always portray the sequence of events exactly as they occurred. I have also been reported to the board because a fellow veterinarian told a client that "I have many complaints made against me." These were complaints not about my standard of care, but about my refusal to euthanize a healthy pet and/or to pursue payment when it has been avoided.

    The fact that a colleague complained about me is hurtful enough, but to be a coward about it is pathetic. Further I was never provided an opportunity to explain myself.

    If I believed that patients were at risk due to the actions of another vet I would extend a common courtesy to them and talk, or at least give them the benefit of the doubt.

    To paint yourself as being "honest" about your mistakes and then not be completely honest with all of those involved is not helping to resolve the problem, which it appears you are trying to convince us of.

    Explaining all options to your client is your obligation and being responsible for the care and concern of your patients is also your obligation, participating in slander is undermining to both your credibility and professionalism.

    Dr. Wilson the author of Veterinary Law and Ethics has a wonderful segment about just this scenario. It can be found on his online class available through Iowa State. He advises contacting the vet in question and actually helping to resolve the concern.

    I read your blog often, and I too say to myself many, many times as I am writing my own blog, "I'm going to regret this later." There have been many blogs I have written, published, and removed because I let my raw emotion type.

    Sincerely,
    Krista Magnifico, DVM

    ReplyDelete
  2. Speaking from the client side, I totally disagree with Dr. Magnifico. Having been told by another professional that this particular individual had a record of such "mistakes" and having to clean up after this mistake I believe Dr. Bern did exactly the right thing. As a client who had just had his pet put through unnecessary and complicated surgery (who is not out of the woods yet) and having met evasive and butt-covering behavior from the previous vet. I would want any and all information I could get to make sure that I could do whatever possible to make sure that the chances of another pet owner going through something like this was minimized. Sometimes being mealy mouthed does nothing to help the client or the profession. Sometimes you owe it to your client and the pet owning public at large to call a spade a spade. As far as your accusation of "slander" goes, I don't see anywhere in this blog entry where the offending individual is identifiable.

    ReplyDelete
  3. Dr. Magnifico, I respect your opinion, but disagree with you on several points. First of all, I was not relying on merely the opinion of the client or even my staff. I had multiple facts that formed my own view. Let me summarize those facts:
    1. Physical exam of the dog showed a distended, fluid-filled abdomen
    2. Radiographs from 12/12 showed a linear metallic thread or wire inside of a mass within the abdomen
    3. Radiographs from 8/6/13 showed the exact same object in the same mass in the same position within the abdomen.
    4. Clinical symptoms were not consistent with a GI foreign body.

    I also had legitimate reasons to question the quality of the other veterinary office. Several facts revealed practices that fall below accepted measures of veterinary and professional care.
    1. The December radiograph showed only half of the abdomen.
    2. Neither radiograph showed two views, only one lateral view each.
    3. The disc with the December views had multiple views of many other pets. Within almost half of the views you can clearly see human fingers, hands, and even entire forearms.
    4. The fact that the human appendages were in many radiographs shows not a one-time accident but a regular practice.

    These are all hard facts, independent of talking to anyone. I would challenge any veterinarian who feels that these facts show proper standards of veterinary care. They are certainly NOT what we are taught during our training. And I stand by the fact that they are sub-standard.

    If you want to take issue with my initial opinion about the vet having left a sponge in, let me point out a few things. First, I was very deliberately clear to the owner several times that though I suspected this was the case, I couldn't be certain without the surgery being performed. At no point did I absolutely accuse the other vet without knowing what was actually in the abdomen. Second, I had two newly graduated vets training with me when I was looking at the x-rays. I showed them the images, described the case, and asked them what the object might be. After a few seconds of thought, one of them mentioned the possibility of a surgical sponge. And that was before I shared my own thoughts on the case. So if a new graduate suspects a surgical sponge, and I as a doctor only looking at x-rays suspects a surgical sponge, why is it difficult for the vet who actually PERFOMRED the surgery to not consider that he may have left a sponge in the abdomen?

    As far as having a "holier than thou" opinion, I would interested in knowing why you believe this. First of all, I stated multiple times that I have made mistakes of my own, and was clear in giving an example. Do you want more? I have gotten dosages wrong on medicine. I have made the wrong diagnosis. During routine spays I have accidentally nicked the urinary bladder and spleen. I could continue, as I am only human. But the differences is that in each and every case I informed the owner and made the situation right. Even in a situation where the owner would never have known otherwise I still told them. To me this is being moral and honest, rather than trying to hide my mistakes. I am willing to face the consequences of my actions, and am aware that any of my mistakes could result in malpractice lawsuits or veterinary board investigation. I have found that most people are willing to accept mistakes as long as they are handled properly and not hidden. But if I make a mistake, I need to be held accountable for my actions.

    Second, only twice in my career have I ever thought a veterinarian actually committed malpractice, including this time. I know not everyone has followed my blog closely over the 5 years I've been writing, but I have never bad-mouthed a doctor before, and many times have come to the defense of vets I didn't know when a client has made complaints. I'm well aware of giving my colleagues the benefit of the doubt, calling them, and keeping open lines of communication. I have done so many times, though there would be no way for you to know that.

    ReplyDelete
  4. As far as me "slandering" this vet....first of all, as Rich pointed out, I have deliberately not given any names, even the dog's name. Second, and I might be acting as a "grammar Nazi" here, your accusation of slander is incorrect. Slander is defined as "The action or crime of making a false spoken statement damaging to a person's reputation." If you want to get very technical, you're accusing me of libel, which is the same thing but as relates to written. The key words here are "false statement". At no point have I made any false statements whatsoever. I have presented the exact facts, all of which can be proven by others. So at no point have I slandered this vet. Any mistakes that he made are true. After all, you can't deny the fact of a board-certified surgical specialist finding a laparotomy sponge within a granuloma that had been first noticed at least 8 months prior. And in any case I can't "slander" or "libel" someone, hurting their reputation, without mentioning who they are.

    I have had clients tell other vets things about me that I never said or did, so I'm well aware of that possibility. Because of my own experiences I'm very, very careful when accusing a vet of wrongdoing. However, I also want to uphold the standards of our profession and when there is clearly bad medicine, especially one that threatens the life of a pet, I think I do have a responsibility to call a spade a spade. Vets who perform malpractice and sub-standard care only hurt pets and people, as well as bring down the profession as a whole. Why would I defend those people?

    ReplyDelete
  5. Well, I understand that there are always two sides to a story. But, if a sponge is left during a surgery in a pet's abdomen, that is not the client's imagination. That is a surgical mistake and no amount of he said she said will change the fact that the sponge DOES NOT belong in a dog's belly. In a he said she said situation, usually there is an hypothetical sponge...I do believe in this case, there was an actual REAL sponge (physical evidence) so I am confused on how that would be slander. That sponge is considered proof of a mistake and a third vet found it. I always thought for this to be slander, you would have to identify the people in question and I do think this blog was a general rant. I do not recall seeing any names of persons nor businesses. A blog is a place where we can share our frustrations and we are allowed to point out that in veterinary medicine, there is incompetence and getting defensive about it will not change the fact. Closing your eyes will not make it go away either. To make sure I a not accused of slander too, let me be clear. I would bet that incompetence exists in all fields of work.

    Now, let me play devil's advocate. Isn't accusing someone of slander, when it is not based on actual slander since no names were published and there is physical proof of a mistake, a form of slander in itself? Your basically accusing someone of falsely slandering someone. I looked up the definition on Wikipedia for slander: Defamation—also called calumny, vilification, or traducement—is the communication of a false statement that harms the reputation of an individual, business, product, group, government, religion, or nation. Based on that, and what I know about veterinary code of ethics and professional behavior I find your rant about slander interesting. If someone accused me of slander on my blog, I would call my Vet Association to investigate that vet. In my veterinary mind, if you falsely accuse another vet of slander, isn't that unprofessional behavior if no actual slander happened in the first place? So, if you accuse someone of slander and they did not actually slander someone, couldn't that be seen as harming the vet's reputation in a written and public forum? Since you are specifically attacking the blogger ( a vet) and naming yourself on a public forum, aren't you liable? Anyways, just food for thought, think about it because being an outside party, I am looking at both point of views.

    Regardless, I wish for no one to loose their licence if they truly love their job, but sometimes I do wish that some vets would stop being vets since they seem to do more harm than good :(.

    ReplyDelete
  6. I suspect we all have vets like that in our regions. I am dealing with a similar one now and basically, as a vet, it is my responsibility unde the professional codes, to contact the vet to allow them to defend and explain etc. However, as wwe are now starting minimum standards of practice in New Zealand, there is a new system where the public and veterinary nurses can register a letter of concern against a vet. This will be followed up by the Vet Council and if serious, can be upgraded to a formal complaint and investigation. Usually it will just sit on the vets records and if there are a number of them, a full investigation can be launched.

    http://www.vetcouncil.org.nz/complaint.php

    I resent that people can get away with repeated issues but it is difficult to get an external body to take action. Perhaps this will work!

    I understand that you have to be careful with publishing material - but if it is true, I dont believe it can be libel or slander.

    ReplyDelete
  7. Dr. Magnifico,
    I’m really confused by your post. Dr. Bern owes his only allegiance to his client and her pet.
    While I am neither an attorney nor a veterinarian, as soon as I read “surgical sponge” my first thought was “law suit” So it isn’t like Dr. Bern gave the client some revolutionary idea.
    In what way does he owe the previous veterinarian a call? Should he call the other vet and tell him how to identify sponges on x-rays? Or perhaps explain that sponges should not be left in? I think that what you are suggesting is that Dr. Bern call and warn the other vet of a potential malpractice suit, which certainly sounds unethical to me.

    If I were in this case and I found out that Dr. Bern called the first vet without my knowledge, I would be furious. I came for a second opinion, not someone to go straighten out vet #1. And if Dr. Bern caused vet #1 to hide/change evidence, he would be guilty as well. Vet #1 is not his client nor his employee, Dr. Bern owes him nothing.

    If you took your car for a second opinion, would you expect mechanic #2 to call mechanic #1 and ask “so, dude, why did you put the brakes on wrong?” What if you were injured in an auto accident and mechanic #2 found the mistake on the brakes- would you expect him to call mechanic #1 and give him the opportunity to mount a legal defense and hide evidence?

    It is professional secret brotherhoods like you are suggesting that makes people distrust some professions.

    ReplyDelete
  8. I'm going to come to the defense of Dr. Magnifico here, as I understand the point she was trying to make, even if I disagree with the application in this instance. Many times clients misrepresent what a veterinarian has told them, most of the time through misunderstanding. So when they go to another vet they may complain or say something that isn't actually true, all without being deliberately deceitful. Let me give you a personal example....Many years ago I recommended that a client neuter her dog. The dog had a small, unusual mass on the skin so I recommended removing the lump and sending it off to the lab to see if it was anything to be concerned about. I found out later that the client had gone to another vet and told him that I had said to her that her puppy had cancer and would die unless the mass was removed. She took what I had said as something simple and somehow heard something bad and extensive. Over my 16 years in practice I have seen this happen many times to me and to other vets. In these cases it is a professional courtesy to call the other doctor and get the story directly, rather than relying on the client's memory and understanding. This helps the pet as it allows both doctors to confer and get the complete story with accurate details. It has nothing to do with any conspiracy, "secret brotherhood", or a warning from one doctor to another. There are also many times when a client will bad-mouth a doctor because they didn't like the diagnosis or the doctor's attitude, even when the vet did everything appropriate and made the right diagnosis. Again, it's professional courtesy and good ethics not to repeat what are sometimes unfounded comments from the client and instead found out the real facts from a copy of the medical records or a discussion with the doctor. I believe that this is the kind of situation that Dr. Magnifico was talking about.

    While I understand and appreciate her sentiment, and would typically agree, I disagree with Dr. Magnifico in this specific case because the facts are undeniable and not based on a client's opinion. In fact, the rather damning facts are based directly on the records and diagnostics of the vet in question.

    ReplyDelete
    Replies
    1. Sad that you're back pedaling now, just to take up for another in your field.
      Good post, initially. Now you take up for her when she hadn't a logical leg to stand on, nor a clear and cogent argument? That's just spineless. You vets are no different than so many other humans in a given field; covering each other's backs. You are reading into things and saying things on her behalf that she never said. Face it. She's an ignoramus who made a moronic, knee-jerk defense of vets. It's no surprise, as she herself claims to be a vet. Gosh, it's really like watching kindergarten children. I've seen people in many professions screw up; legal(many close friends are attorneys), medical, etc.
      I've never seen the pervasiveness of dishonesty and putting themselves before those they're meant to serve first, except in politics. I've lost respect for the writer of this article. Thankfully, I've found a few wonderful holistic vets who are constantly reading, researching and learning ways to improve and enhance their care and practices. When I talk to them about nutrition, RAW food is a no-brainier and they don't have a hissy-fit when I don't have my dogs DE-sexed with this ridiculous mandatory spay/neuter culture.

      Delete
    2. Understanding someone's point of view is hardly "spineless". I also don't see how it is backpedaling to understand where someone is coming from. I challenge you to to re-read my reply above and see how I am somehow defending her when I only stated that I understand what she is trying to say and then gave a specific example from my own history and experience.

      I will also say that if you think that holistic vets are somehow unique you are quite mistaken. Most vets "are constantly reading, researching and learning way to improve and enhance their care and practices". Holistic vets may reach different conclusions, but they are no "better" or worse than any other vet. They are human and just as prone to mistakes, poor communication, and every other human frailty. You have found vets who fit your need and beliefs, but the idea that raw food is better goes against the vast majority of international research and specialist.

      Delete
  9. First of all, medical or veterinary, foreign body left inside an animal is not debatable.
    Secondly, that same Dr. Wilson is not remotely in favor of incompetent vets remaining in practice.

    ReplyDelete
  10. Interesting discussion. Although I'm in a different field, I deal with such ethical issues.

    Theoretically, I'm thinking that there may be benefits in contacting the vet in question directly (with the owner's knowledge.) It might serve as a wake up call to prevent further mishaps before the licensing board would be able to intervene. If I found myself in that boat, I might even seek consultation on the ethical/legal aspects of the situation, to make sure I've documented and handled the situation appropriately myself. Thankfully, I've never come across anything that would equate to this.

    I understand that there is risk that records may be destroyed, however, I think that between the documentation that the family has and the documentation Dr. Bern has, there would be plenty of evidence to pursue formal action. And my guess is that if some of the work is this sloppy there would likely be other issues that a licensing board could easily pick up on.

    ReplyDelete
  11. Today I did not have a good experience with my vet. I took my cat to this vet because my cat is eating less and less. When my cat got to the office and was adamant about having the exam done by the vet, the vet told me this was enough and he was not going to deal with my pet!!He did not take a lot of time and he did not even examine the pet. This vet got mad when my cat urinated in the floor; my cat was afraid of the exam. He said that the only way he would deal with my cat it was sedating her(this was a small cat, not a lion). In other words, he did not administer any treatment to the cat at the office and gave me medications to administer in my house.
    Now, I am thinking of getting a second opinion and to take my cat to another vet, of course. When I left this vet's office I myself thought if veterinarian medicine was the right career for this "doctor".

    ReplyDelete

Thank you for making a comment on my blog! Please be aware that due to spammers putting links in their comments I moderate every comment. ANY COMMENTS WITH AN EXTERNAL LINK NOT RELATED TO THE TOPIC WILL LIKELY BE DELETED AND MARKED AS SPAM. If you are someone who is posting links to increase the traffic to another website, save me and you the time and hassle and simply don't comment. To everyone else.....comment away! I really do enjoy hearing from readers!