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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 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.