Ethics Question: as a vet, what would you do?

[animalrie]

I was shadowing the other day and saw a case that raised a few ethical questions. A dog was brought in to the specialty hospital I shadow at directly from his regular vet. He had been having a minor surgery at the reg vet and had somehow fallen out of his cage as a tech was placing him in or taking him out. He came to us paralyzed and after doing some myelograms and CTs, the surgeon I shadow believed that he may not recover and would likely have to be euthanized.

So, if you were the vet responsible for the dog when he fell from his cage, what would you do? I asked the surgeon this and he said while the "right" thing to do would be to pay for all of that animal's medical care, he also said that if the client sues, this is essentially an admission of guilt and could potentially lead to you losing your license.

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[AGSIII]

I wouldn't take my dog to that vet.

 

[Minnerbelle]

I would apologize profusely and express my condolences and turn it over to my boss who may decide to pay for all those expenses at the specialty hospital +/- cost of new dog (as horrible as that is, it's at least something we can offer) and initial puppy care and sterilization if they still want to come to our hospital; or she may turn it over to our malpractice insurance carrier who will likely settle. Probably depends on how things were initially communicated. But **** happens. Dropping a dog by the tech was likely a very unfortunate accident. If there was some sort of issue with protocol in the hospital that led to the dog getting dropped, we would change protocol and let the owners know that our hospital has changed things due to this tragedy. But otherwise you can't help some accidents from happening. And usually in these kinds of situations, how you communicate to the owners tend to play a pretty big role in how they respond. No doubt the owners are devastated. And some people will be angry at you regardless of what you say. But many will be very forgiving and will actually feel bad for the tech/personnel involved for what had happened if they have the perception that you were providing their pet excellent care, and that you were honest and sincere about a bad accident, and that you are trying to make things right. I mean what more can you do?

 

[katryn]

I'm with Minner. You explain the accident (I assume the tech did not intentionally drop the dog), express your condolences, and sit down to thoroughly discuss what happened and see if policy changes need to be made. For some owners, that is more than enough, and most even when upset, know that accidents happen. If the owners want compensation for what happened, that is usually handled privately with the clinic owner, or handed over to a malpractice advisor (depending on how far the pet owners take it).

Don't get me wrong, I would feel terrible for these people (owners and staff), but accidents do happen and shouldn't necessarily be blamed on anyone. Letting yourself feel personally guilty over things like this is a good way to burn out.

 

[Fly Racing]

I'm really surprised to hear that a vet should be concerned over losing their license over not only an accident that they did not cause, does not involve lack of skill or education, and an accident that they could have no way controlled. I just can't see the vet board revoking a license for this; not even to "make an example" of the vet. Of course the vet is responsible for their staff, but people still need to be reasonable. Is this person a bad vet and is this likely to ever happen again?

As to what the involved vet should do, that is a tough one. This case is unique because the accident and outcome, in my opinion, is not part of the "clients accepted risk" of complications when seeking veterinary care. In other situations that do fall more within the range of risk the client assumes (and is therefore often told about in advance), my experience of when the vet care has made things worse for a horse (cause joint infection after injections, coliced during hospital stay, caused corneal abrasion/ulcer during surgery, post op pneumonia, limb fractures during hospital stay including surgery recovery, and others), in none of the cases was the subsequent vet care offered at no charge and none of the euthanized horses were replaced. Even in those situation, I feel like if I were the vet I could not accept anything above cost in treating those complications. For the people invovled, a case like this would be horrible to deal with. I really feel for the tech.

As only a vet student, I do not fully understand the process and ramifications of using malpractice insurance coverage to cover those costs and offer payment to the client, but since that is what it is there for, I imagine this would be the appropriate time to use it. The insurance agent should have been notified immediately to attempt to settle without the case entering the courts.

 

[StartingoverVet]

I'm really surprised to hear that a vet should be concerned over losing their license over not only an accident that they did not cause, does not involve lack of skill or education, and an accident that they could have no way controlled. I just can't see the vet board revoking a license for this; not even to "make an example" of the vet. Of course the vet is responsible for their staff, but people still need to be reasonable. Is this person a bad vet and is this likely to ever happen again?
.

I agree. Something doesn't add up. Maybe there are details the OP left out, but although this may be a negligent act on the tech's part, I don't see how there is anything rising to the level of professional incompetence, gross negligence, or a pattern of substandard care that would lead to the revocation of a license.

Accidents are going to happen in every practice. Mistakes are going to be made by every single licensed vet. Those acts will lead to pet deaths. That is unavoidable because we are all human and fallible.

If people are advocating keeping silent about reality to avoid a censure hearing, then I am really disappointed about the state of the profession. That is the quickest way to lose the respect of clients, and will do a huge disservice to the industry in the long run. I am really hoping that is just one ignorant opinion and not a trend that is starting out there.

 

[that redhead]

This case is unique because the accident and outcome, in my opinion, is not part of the "clients accepted risk" of complications when seeking veterinary care.

This is the exact reason that I'm having trouble coming up with an answer for this scenario. Sure, clients sign a form stating the understand the risks of certain diagnostic tests, treatments, anesthetic risk, etc...but I've never seen a clause about accidental injury while at the clinic - falling from a cage or table, maybe tangling with another animal there when a bunch of animals are in the back or being walked at the same time.

I think offering sincere condolences and following up with a nice card from the clinic is a no-brainer in this scenario. But I don't think that paying for all of the care and follow-up care (not to mention monetarily replacing the animal) is the logical next step, and certainly not something I would offer as sad as it is. If the client expected me to recoup all of their losses financially, I would consult legal counsel and let them lead.

 

[allygator13]

I don't think it's far fetched to pay for the further medical care. We had patients that came to the surgery practice I worked at that came from other clinics where things like this happened and the clinic paid for it. One patient was boarding with a clinic and became acutely lame on one of its legs while it was there (no known inciting incident) and the clinic paid for its care.

 

[DVMDream]

One patient was boarding with a clinic and became acutely lame on one of its legs while it was there (no known inciting incident) and the clinic paid for its care.

Why? The clinic is agreeing to care for the dog while it is in the kennels.. fed it, walk it, etc, but the dog getting injured is still the client's responsibility unless it was direct injury from something the clinic actually did wrong. Like the dog getting loose and hit by a car.

I think of it this way: If you ask your friend to pet sit for you and your dog starts limping you don't expect your friend to pay the vet bill. So why put that responsibility on a kennel?

 

[Minnerbelle]

It's one thing if the dog did something to injure itself, but the tech dropped the dog... If you bring your pet to the hospital you go with the expectation that your dog will not encounter debilitating trauma. You expect that the staff will not drop your pet. I would be pissed as an owner if I were told "oopsie, sorry. We're not responsible"

I wouldn't punish the tech for an accident like this, but if it weren't for her, the dog would not have been dropped. I don't think this is the same thing as dog just getting scratched/lame through playing in doggy day care. I personally would try to compensate at least the medical care as long as the owner is being understanding and not already threatening to sue (in which case I'd just turn over to PLIT).

It could also be different clinic culture, but my hospital is very client services oriented and we usually do more than we need to in order to right any possible wrongs. This goes as far as never exceeding the estimate given for procedures, even if it ends up being more because it turned out to be a little more complicated than initially thought. A lot of other clinics won't make the business decision to do this, but apparently business is booming for us, so I don't think it's wrong. It works for us. Plus I'm just the associate. I don't make the rules.

 

[allygator13]

Why? The clinic is agreeing to care for the dog while it is in the kennels.. fed it, walk it, etc, but the dog getting injured is still the client's responsibility unless it was direct injury from something the clinic actually did wrong. Like the dog getting loose and hit by a car.

I think of it this way: If you ask your friend to pet sit for you and your dog starts limping you don't expect your friend to pay the vet bill. So why put that responsibility on a kennel?

I honestly have no idea why they paid for it, but they did. So my argument was that when an employee injures an animal, I don't think it's ludicrous for the hospital to pay for its care resulting from it getting hurt by an employee, accident or not.

 

[LetItSnow]

I don't think it's far fetched to pay for the further medical care. We had patients that came to the surgery practice I worked at that came from other clinics where things like this happened and the clinic paid for it. One patient was boarding with a clinic and became acutely lame on one of its legs while it was there (no known inciting incident) and the clinic paid for its care.

I don't think it's far-fetched, either. The injury was caused by personnel at the clinic, and it wasn't, I'm sure, a possible 'adverse outcome' of treatment that the client was warned about. So, whether it was negligent or not TO ME would make no difference - I'd own the accident, take responsibility, and cover the costs. Not just throw the animal back at the owner with what amounts to a shrug and an apology. I do think, based on what the OP reported, that it was just a commonplace accident that had a tragic outcome, but the fact that it's a non-negligent accident doesn't make you any less responsible. It just makes you less negligent.

In regard to DVMD's comment, I think the difference TO ME is that in the example she used (pet sitting, dog starts limping) ... you don't really know what caused the limping. Self-induced soft-tissue by the dog? Orthopedic injury by the dog? Flair-up of a tick-borne disease? You can't really say that the pet-sitter's care caused it. Whereas in this case you know exactly what happened: the clinic personnel dropped the dog. If I were pet-sitting for someone and I directly caused an injury, I'd certainly offer to pay the care.

I guess that's just my take on 'responsibility'.

This is all how I'd personally want to respond. In the end, as to what I'd <actually> do, I'd call the owner, explain what happened, apologize profusely, talk about the current state of the dog and what its urgent care requirements are, get off the phone, call my legal counsel, and let further action be dictated by them. That's the reality of the modern world.

Somebody earlier in the thread (I think FlyRacing) said something like "people still need to be reasonable." I kinda laughed. Unfortunately, many people AREN'T reasonable.

 

[DVMDream]

In regard to DVMD's comment, I think the difference TO ME is that in the example she used (pet sitting, dog starts limping) ... you don't really know what caused the limping. Self-induced soft-tissue by the dog? Orthopedic injury by the dog? Flair-up of a tick-borne disease? You can't really say that the pet-sitter's care caused it. Whereas in this case you know exactly what happened: the clinic personnel dropped the dog. If I were pet-sitting for someone and I directly caused an injury, I'd certainly offer to pay the care.

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No, in the above post talking about the limping dog from the kennel it started limping out of nowhere. As allygator stated:

I don't think it's far fetched to pay for the further medical care. We had patients that came to the surgery practice I worked at that came from other clinics where things like this happened and the clinic paid for it. One patient was boarding with a clinic and became acutely lame on one of its legs while it was there (no known inciting incident) and the clinic paid for its care.

So you have no idea still what caused the dog to limp. Was it self-induced by the dog, tick borne disease, coccidomycosis, etc... there is no known cause. Why would the clinic be responsible. It is exactly like the example that I used.


Of course if my tech dropped the dog out of a kennel, I would be willing to pay for costs. That isn't a normal or expected complication from being in the hospital. And while it was just an accident, it sure was a crappy one.

However, I don't get why in allygator's scenario the clinic paid for the limping dog's care... it makes zero sense to me unless that clinic is just not telling the full story and they really did do something wrong. But simply a dog becoming lame while boarding should not have to be paid for by the vet.

 

[dyachei]

\


No, in the above post talking about the limping dog from the kennel it started limping out of nowhere. As allygator stated:



So you have no idea still what caused the dog to limp. Was it self-induced by the dog, tick borne disease, coccidomycosis, etc... there is no known cause. Why would the clinic be responsible. It is exactly like the example that I used.


Of course if my tech dropped the dog out of a kennel, I would be willing to pay for costs. That isn't a normal or expected complication from being in the hospital. And while it was just an accident, it sure was a crappy one.

However, I don't get why in allygator's scenario the clinic paid for the limping dog's care... it makes zero sense to me unless that clinic is just not telling the full story and they really did do something wrong. But simply a dog becoming lame while boarding should not have to be paid for by the vet.

In practice, I had a dog that I was looking at and the owner was taking him off the table on their own and dropped him. the dog started limping. They didn't want to immediately get radiographs. So we did an orthopedic exam before he left and since it was a mild limp, we gave them NSAIDs and instructed for cage rest. Later, when he continued to limp, the owners filed a complaint against us. I talked to them on multiple occasions regarding it. We ended up doing radiographs for free since it happened at the clinic and the owners informed me "we know it's our fault, but you can afford the treatment and we can't."

Well the dog had torn his CCL and needed surgery. We did not pay for it. We ended up losing the client, but you know, clients that think that the clinic should pay for their mistakes are clients we don't really want in the clinic. Anyone with that kind of philosophy is not really going to be the kind of client to keep. even if they badmouth you online.

 

[Escalla]

In practice, I had a dog that I was looking at and the owner was taking him off the table on their own and dropped him. the dog started limping. They didn't want to immediately get radiographs. So we did an orthopedic exam before he left and since it was a mild limp, we gave them NSAIDs and instructed for cage rest. Later, when he continued to limp, the owners filed a complaint against us. I talked to them on multiple occasions regarding it. We ended up doing radiographs for free since it happened at the clinic and the owners informed me "we know it's our fault, but you can afford the treatment and we can't."

Well the dog had torn his CCL and needed surgery. We did not pay for it. We ended up losing the client, but you know, clients that think that the clinic should pay for their mistakes are clients we don't really want in the clinic. Anyone with that kind of philosophy is not really going to be the kind of client to keep. even if they badmouth you online.

I don't know how people sleep at night pulling that kind of crap.

 

[orca2011]

I don't know how people sleep at night pulling that kind of crap.

I was shadowing at a hospital once and this lady with a cane (who had admitted she need knee/hip surgery in the middle of the appointment but couldn't afford it) tripped over her own dog and fell. She then tried to file a complaint/potential law suit against the hospital that we had uneven floors which caused her to trip.

They definitely try to pull that kind of stuff. Not quite the same, but they'll even try to get you for things like that apparently.

 

[animalrie]

I agree. Something doesn't add up. Maybe there are details the OP left out, but although this may be a negligent act on the tech's part, I don't see how there is anything rising to the level of professional incompetence, gross negligence, or a pattern of substandard care that would lead to the revocation of a license.

Accidents are going to happen in every practice. Mistakes are going to be made by every single licensed vet. Those acts will lead to pet deaths. That is unavoidable because we are all human and fallible.

If people are advocating keeping silent about reality to avoid a censure hearing, then I am really disappointed about the state of the profession. That is the quickest way to lose the respect of clients, and will do a huge disservice to the industry in the long run. I am really hoping that is just one ignorant opinion and not a trend that is starting out there.

Sorry, I think I misunderstood the vet and the concern was actually about if the client sued. In a lawsuit, paying for the dog's care would essentially be an admission of guilt.

I'm thinking that personally I would still feel the need to "do the right thing" and pay for his care and would have to let my lawyers/malpractice handle the backlash of that.

 

[eventualeventer]

Why? The clinic is agreeing to care for the dog while it is in the kennels.. fed it, walk it, etc, but the dog getting injured is still the client's responsibility unless it was direct injury from something the clinic actually did wrong. Like the dog getting loose and hit by a car.

Actually, it IS the responsibility of the vet clinic if a pet gets loose and gets hit by a car. The clinic is responsible for anything that might reasonably have been prevented or was due to human error, even if it falls in the realm of "s*** happens" when you look at the bigger picture of running a practice that is staffed by human beings. PLIT has optional bailee coverage to cover such events (bailee insurance is insurance to cover something that you are keeping for someone else, as in a hospitalized patient).

 

[DVMDream]

Actually, it IS the responsibility of the vet clinic if a pet gets loose and gets hit by a car. The clinic is responsible for anything that might reasonably have been prevented or was due to human error, even if it falls in the realm of "s*** happens" when you look at the bigger picture of running a practice that is staffed by human beings. PLIT has optional bailee coverage to cover such events (bailee insurance is insurance to cover something that you are keeping for someone else, as in a hospitalized patient).

Reread my post. I stated EXACTLY what you just said. The vet clinic is responsible if something happens like the dog getting loose. However, a dog simply acquiring a limp for no known cause is not the responsibility of the clinic, sure the clinic might just pay for it to not have to deal with the owner getting upset. We all know people can't be rational. If you left your dog with your best friend and it became limp suddenly you don't expect your friend to pay for it, so why do people expect different of a vet clinic? This doesn't include situations where clearly an accident happened at the clinic resulting in injury. I'm talking about no inciting injury, no "**** happened", the dog just started limping.... maybe it has a fungal infection like valley fever.

 

[Minnerbelle]

Haha I like the regional differences. I've never put fungal disease (valley fever especially) on my list of ddx. It's Lyme/Anaplasma galore vs. cruciates here instead for a limpy dog

 

[DVMDream]

Haha I like the regional differences. I've never put fungal disease (valley fever especially) on my list of ddx. It's Lyme/Anaplasma galore vs. cruciates here instead for a limpy dog

It is one of the top 3 things that is on a ddx for limping dogs in AZ, especially if they also have a cough.

 

[eventualeventer]

Reread my post. I stated EXACTLY what you just said. The vet clinic is responsible if something happens like the dog getting loose. However, a dog simply acquiring a limp for no known cause is not the responsibility of the clinic, sure the clinic might just pay for it to not have to deal with the owner getting upset. We all know people can't be rational. If you left your dog with your best friend and it became limp suddenly you don't expect your friend to pay for it, so why do people expect different of a vet clinic? This doesn't include situations where clearly an accident happened at the clinic resulting in injury. I'm talking about no inciting injury, no "**** happened", the dog just started limping.... maybe it has a fungal infection like valley fever.

I apologize; I completely misread.

 

[DVMDream]

I apologize; I completely misread.

No worries.

 

[pinkpuppy9]

This is one of those situations where the phrase "Animals taking care of animals" fits pretty well. Not the best thing to say to a client as a reason for the incident, but the client should know what happened and has the right. So what if you are admitting guilt? Or you could be a rich practice and settle with the client just so they'll let the case close....

I honestly have no idea why they paid for it, but they did. So my argument was that when an employee injures an animal, I don't think it's ludicrous for the hospital to pay for its care resulting from it getting hurt by an employee, accident or not.

I agree. The employer is 100% responsible for all actions of his/her employees, whether you verbally tell a client the wrong medication instructions or drop a dog. Think about it this way: you're at a theme park, and you get seriously maimed on a ride. Investigation shows that your injury was due to to a ride operator error. You don't sue Bob, the operator. You sue the theme park.

I was shadowing at a hospital once and this lady with a cane (who had admitted she need knee/hip surgery in the middle of the appointment but couldn't afford it) tripped over her own dog and fell. She then tried to file a complaint/potential law suit against the hospital that we had uneven floors which caused her to trip.

They definitely try to pull that kind of stuff. Not quite the same, but they'll even try to get you for things like that apparently.

I was working on a hot summer day, and we had a mother/daughter in the exam room with the vet (I was at the front desk). I look out to see a 90ish year old woman flat on her back in the parking lot. Turns out it was the mother/grandmother of our clients, and they had left her in the car (with no keys and the windows rolled up). She tried to come inside for some A/C, but was so out of it by that point she collapsed on our three steps leading to the front door. So far, no legal action. But we were sure to thoroughly document the situation and clearly offer an ambulance. The clients weren't very concerned. "Well maybe if they had a handrail on their steps, you wouldn't have fallen!"