What happens when you mess up BADLY?

[that redhead]

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You can even mess up even after death.

I had a neuro case case on a weekend once - rabies was a differential but very, verrrry low index of suspicion in my opinion. I took and submitted a wrong/incomplete part of the brain to the state lab. It was my first weekend on as an attending in a different state (different labs sometimes want slightly different sections but that is not an excuse), and I don't know what was going through my head. Rabies cases were like second nature to me based on where I trained, but for whatever reason I blanked and dropped the ball.

Everyone in contact with that animal had to have post-exposure vaccination series simple because it was a a "not negative" (i.e. what they tested was negative but since they didn't receive a complete samples, they couldn't rule it out 100%.) I felt like a complete idiot.

This may be a silly question, but can you just submit the whole brain and let them take the sections they want? Or will they get fussy because they have to do more work?

 

[hazelmoo]

What happens when somebody in the veterinary profession has been exposed to a rabid, or possibly rabid animal. Do they still have to get the post exposure vaccinations or does the vaccinations they get before starting their work cover them.

I am pretty sure they still have to get them, if we have a rabid animal at the wildlife center I would still have to get post exposure vaccines even though I have already been vaccinated.. But I don't think you have to get as many as the people who don't have the vaccines (even though they shouldn't be dealing with those animals in the first place)

 

[hazelmoo]

you still have to get post exposure vaccines, just less of them

Oh. ninja'd me!

 

[DVMDream]

You can even mess up even after death.

I had a neuro case case on a weekend once - rabies was a differential but very, verrrry low index of suspicion in my opinion. I took and submitted a wrong/incomplete part of the brain to the state lab. It was my first weekend on as an attending in a different state (different labs sometimes want slightly different sections but that is not an excuse), and I don't know what was going through my head. Rabies cases were like second nature to me based on where I trained, but for whatever reason I blanked and dropped the ball.

Everyone in contact with that animal had to have post-exposure vaccination series simple because it was a a "not negative" (i.e. what they tested was negative but since they didn't receive a complete samples, they couldn't rule it out 100%.) I felt like a complete idiot.

Speaking of pathology things, I have a case you'd find interesting. Maybe. I'm rather certain our pathologist was quite excited about this case because her description of just the one organ was nearly a page long.

 

[LetItSnow]

you still have to get post exposure vaccines, just less of them

Most importantly (to me anyway), you don't have to get the damn Ig portion. Since that is supposed to go at the site of exposure,
it can be quite painful pumping a small site like a finger full of Ig.

 

[dyachei]

Most importantly (to me anyway), you don't have to get the damn Ig portion. Since that is supposed to go at the site of exposure,
it can be quite painful pumping a small site like a finger full of Ig.

also true.

 

[WhtsThFrequency]

This may be a silly question, but can you just submit the whole brain and let them take the sections they want? Or will they get fussy because they have to do more work?

You can. The issue with this is that if you send them the whole thing and it tests negative, you no longer have any tissue left to trim in to determine what it *actually* was (some other infection, a tumor, etc). To be fair, some labs will send it back to you after it tests negative, but that can be days of being held at only about fridge temperature, and the tissue will degrade (neuro tissue is particularly prone to this), other contaminant bugs will start to grow, the histo will be crappy, etc. So you may rule out rabies, but you risk not being able to figure out what it actually was. So the best course of action as a pathologist is to send only the specific samples they require and keep the rest for histology/culture/etc.

Speaking of pathology things, I have a case you'd find interesting. Maybe. I'm rather certain our pathologist was quite excited about this case because her description of just the one organ was nearly a page long.

Gimme gimme.

 

[MassDVMMPH]

I have had my dog (adopted from a local shelter) covered by Trupanion insurance for several years now. If, God forbid, she were to ever need complicated orthopedic surgery or neurosurgery, it would more than pay for itself. I pay about $30 a month with a $1,000 deductible and they cover 90% after that, so if she ever needed a $7,000 surgery as a vet neurologist quoted one of my other patients a few years back (for IVDD), it would only run me $1,600. That is a price I would agree to in a second. The $7,000 price tag, quite frankly, would me hard for me to deal with - and I don't want to be put in that situation. For that reason, I think Trupanion is a bargain. I honestly hope I never have to use it, but the fact that I have it gives me great peace of mind - and that is worth $30 a month. I look at it like I do my homeowner's insurance. I don't ever want to use it, but I'm really glad I have it.

 

[Minnerbelle]

I have had my dog (adopted from a local shelter) covered by Trupanion insurance for several years now. If, God forbid, she were to ever need complicated orthopedic surgery or neurosurgery, it would more than pay for itself. I pay about $30 a month with a $1,000 deductible and they cover 90% after that, so if she ever needed a $7,000 surgery as a vet neurologist quoted one of my other patients a few years back (for IVDD), it would only run me $1,600. That is a price I would agree to in a second. The $7,000 price tag, quite frankly, would me hard for me to deal with - and I don't want to be put in that situation. For that reason, I think Trupanion is a bargain. I honestly hope I never have to use it, but the fact that I have it gives me great peace of mind - and that is worth $30 a month. I look at it like I do my homeowner's insurance. I don't ever want to use it, but I'm really glad I have it.

The owners I always recommend trupanion to are dachshund owners for this very reason. I've had to put down way too many dachshunds for IVDD.

 

[Starry-chan]

The owners I always recommend trupanion to are dachshund owners for this very reason. I've had to put down way too many dachshunds for IVDD.

On that note, I'm not sure how much coverage my Corgi has when it comes to her back and spinal cord. After I adopted her from a shelter in January, I took her to my vet to get a full workup (because I wanted to know if she had any problems that should be treated.) Well, the x-rays showed no evidence of IVDD but she does have spondylosis in L5-7.

Not long after this, I signed up with Petplan and sent them her records, so they could tell me what her exclusions would be. One thing they said is that they would not cover anything relating to the spondylosis in her back. Well, it makes me wonder if they'd cover IVDD. I'm thinking that if it occurred near the area of her spondylosis, then probably not, but maybe if it was way cranial on the spinal cord.

I'm also wondering if she'd be covered if she got degenerative myelopathy (Pembroke Welsh Corgis are a predisposed breed.)

 

[cowgirla]

Thanks to this thread I went to look up premium prices. $~140 to cover both dogs. Still debating if It's worth it or if I should just keep putting money into savings.

 

[CalliopeDVM]

I'm more afraid of injuring (or killing) a pet than I am about the board complaint or potential law suit that might come about because of it. I never really think about those possibilities, but I do think about the damage I could do from a serious mistake. There are times we literally hold a patient's life or death in our hands. That's sobering. When I made a very serious, big mistake that did cost the life of a patient, I was far, far, far more upset about my mistake and the loss of that dog than about a potential law suit or board complaint. What did I do: told the client what had happened, recorded in the record what had happened, and accepted responsibility for my mistake. No lying, no misdirection or prevaricating, no holes in the medical record. They did not report me to the board, nor did they threaten to sue. n=1. It was devastating. But it didn't stop me from learning from my mistake and continuing forward to help thousands of more patients in the following years.

Every vet has a bone pile, if they practice long enough. Hopefully just a small one, but things will happen.


As for pet insurance - I'm a big fan of self-insuring (putting money away regularly in a designated account for pet care), but not 3rd party insurance. Take the premiums you would pay monthly to an insurance company, and start a savings account for your pet instead, IMO.

 

[StartingoverVet]

Another client told me a story about how she boarded her new purebred kitten at her vet and when she returned to pick it up they informed her a tech had mistakenly euthanized her kitten and then they still charged her for the boarding prior to the kittens untimely death!

Not sure if I believe this, but if it were true they don't deserve to be in business. That is ridiculous.

 

[Minnerbelle]

Not sure if I believe this, but if it were true they don't deserve to be in business. That is ridiculous.

And grounds for a malpractice suit and board complaint. Euthanizing the wrong patient is below standard of care...

These are things that then hit the media and sink a clinic. So I'm also in the not sure I believe it camp.

 

[StartingoverVet]

A classic, fantastic example is https://en.wikipedia.org/wiki/Eastern_Air_Lines_Flight_401. Just read the first paragraph and it gives you the gist of it. A perfectly flyable airplane with a relatively insignificant problem flown into the ground by well-trained, experienced crew. All the protocol in the world, but a few circumstantial things and some distraction and a horrible outcome.

I teach this one to my students all the time. Key takeaway is "always fly the plane" first.

IN vet med "always keep the animal alive? " Hmmm. Got to come up with a better takeaway.

 

[StartingoverVet]

And grounds for a malpractice suit and board complaint. Euthanizing the wrong patient is below standard of care...

.

See, but I understand the first part. Mistakes happen. I have heard of this happening elsewhere. Not good, but it happens.
But to compound the error, and still charge the client after a royal f-up. That is like spitting in someone's face.
Clinic: "we accidentally killed your beloved pet due to our negligence and stupidity"
client: <sobbing>
clinic: "but here is the bill for the couple of days where we able to avoid killing your pet".
client: <takes out hunting knife and practicing stabbing maneuvers>

 

[Minnerbelle]

See, but I understand the first part. Mistakes happen. I have heard of this happening elsewhere. Not good, but it happens.
But to compound the error, and still charge the client after a royal f-up. That is like spitting in someone's face.
Clinic: "we accidentally killed your beloved pet due to our negligence and stupidity"
client: <sobbing>
clinic: "but here is the bill for the couple of days where we able to avoid killing your pet".
client: <takes out hunting knife and practicing stabbing maneuvers>

Mistakes happen, yes. But if that mistake is below standard of care or due to negligence, then you are liable for it. This is exactly what malpractice insurance is for. It doesn't necessarily make you a horrible person or anything, but that's a mistake you should never make.

I mean I agree, charging client in this situation would be the most ****ed up thing about this story... This is the part that really would shut the clinic down, and where the media, social media, internet vigilantes, etc... come in. I would personally report this to the BBB, if it actually happened.

The most idiotic part about this is that If it's an honest mistake that you accidentally killed kitten, there is a chance the owners will forgive you and don't report you. But when you proceed to be a dick and try to charge the client, you're just adding fuel to the fire and almost guaranteeing a poor outcome for yourself.

 

[hazelmoo]

Not sure if I believe this, but if it were true they don't deserve to be in business. That is ridiculous.

And grounds for a malpractice suit and board complaint. Euthanizing the wrong patient is below standard of care...

These are things that then hit the media and sink a clinic. So I'm also in the not sure I believe it camp.

In my town last year, a family lost their beloved cat. A couple days later, they found their cat at the local animal shelter. They had checked the shelter every day, and their cat was microchipped, so they were kind of upset when the shelter didn't contact them when the cat was picked up. Any who, there was an argument between father and staff of shelter, and they told him he had to come back the next day when the manager was there to pick up the cat due to some bogus protocol. Father came back the next day and found out they had euthanized the cat on accident that same morning.. So so sad. I've never heard this happening at a vet thank goodness, but it terrifies me to know that it happens in shelters 🙁

There was a vet (in Texas I think.. maybe Fort Worth?) who would keep patients alive who were supposed to have been euthanized by owners request, or even by his own recommendation. He would take them in the back and "euthanize" them without the owners being present. Instead of euthanizing, he would use them for his own research, keeping them alive for who knows how much longer... There are some twisted people on this planet!

 

[LadyOtheFarm]

I do know a clinic that got in trouble (with the owner) when she found out that they had not euthanized her husband's dog. The dog had mild allergies, she didn't want to pay the bills for testing or meds, had her husband bring the dog in and drop it off. A tech took pity on the dog and took it home. Wife never got a bill, got suspicious asked to pay the bill and for proof that the dog was dead. Front desk explained that they had found the dog a new home rather than put down a healthy golden. Wife demanded the dog back, rescheduled the euthanasia and sat through it to guarantee that the dog was put down this time.

-The vet, who after working with him I dislike for many other reasons, tells this story as his reason why he never questions a client about their intent to put an animal down. "The less I know, the better." Nor will he ever say no. (What happens if it's not their pet? How can you justify not giving a client an alternative even when they ask for one? (He won't, he says it breaks his rules))

- What sort of crazy was this lady that the dog couldn't live with someone willing to pay the bills rather than be put down? (Sadly, I kinda know the answer to that. My mother put down 2 cats we had in childhood because they kept peeing on her stuff, nobody else's, just her stuff.)

The whole story just makes me sooo mad, in part because I've heard similar ones throughout my career. I never know who to blame, because sometimes it really is a very sick animal that might have looked healthy that day... but the kind owner wanted to let them go while they still felt good, rather than once the cancer had eaten enough brain tissue to cause massive pain. I get that sometimes there is more to the story, but that is why I prefer the vets that ask. Sometimes you can help. Sometimes you can refer. Sometimes you really can find a new home that has the necessary resources and the client is ok with that, but they don't know any of this is an option unless you ask enough to know that they have weighed their options.

 

[WildZoo]

I do know a clinic that got in trouble (with the owner) when she found out that they had not euthanized her husband's dog. The dog had mild allergies, she didn't want to pay the bills for testing or meds, had her husband bring the dog in and drop it off. A tech took pity on the dog and took it home. Wife never got a bill, got suspicious asked to pay the bill and for proof that the dog was dead. Front desk explained that they had found the dog a new home rather than put down a healthy golden. Wife demanded the dog back, rescheduled the euthanasia and sat through it to guarantee that the dog was put down this time.

-The vet, who after working with him I dislike for many other reasons, tells this story as his reason why he never questions a client about their intent to put an animal down. "The less I know, the better." Nor will he ever say no. (What happens if it's not their pet? How can you justify not giving a client an alternative even when they ask for one? (He won't, he says it breaks his rules))

- What sort of crazy was this lady that the dog couldn't live with someone willing to pay the bills rather than be put down? (Sadly, I kinda know the answer to that. My mother put down 2 cats we had in childhood because they kept peeing on her stuff, nobody else's, just her stuff.)

The whole story just makes me sooo mad, in part because I've heard similar ones throughout my career. I never know who to blame, because sometimes it really is a very sick animal that might have looked healthy that day... but the kind owner wanted to let them go while they still felt good, rather than once the cancer had eaten enough brain tissue to cause massive pain. I get that sometimes there is more to the story, but that is why I prefer the vets that ask. Sometimes you can help. Sometimes you can refer. Sometimes you really can find a new home that has the necessary resources and the client is ok with that, but they don't know any of this is an option unless you ask enough to know that they have weighed their options.

Maybe she wouldn't have been so pissed if they had given her the option to surrender up front instead of going behind her back does seem kind of strange to have the dog euthanized basically out of spite. I can't say I really understand that. But the clinic definitely crossed a line.

 

[dyachei]

Maybe she wouldn't have been so pissed if they had given her the option to surrender up front instead of going behind her back does seem kind of strange to have the dog euthanized basically out of spite. I can't say I really understand that. But the clinic definitely crossed a line.

a lot of people really feel that their animal won't be happy with any other family, etc

 

[Minnerbelle]

We had an accidental euthanasia of a lost pet at a shelter I worked/volunteered at. Huge media circus, and trust me, a head or two rolled. protocol/training was certainly looked into to minimize the likelihood that such thing could ever happen again.

 

[Minnerbelle]

a lot of people really feel that their animal won't be happy with any other family, etc

And sometimes (though not always) it's true.

There are some animals for whom I would agree to euthanize even if in okay or manageable health if the owner were to die, there wasn't a suitable home for the pet, and it was the owner's wish.

 

[LadyOtheFarm]

Maybe she wouldn't have been so pissed if they had given her the option to surrender up front instead of going behind her back does seem kind of strange to have the dog euthanized basically out of spite. I can't say I really understand that. But the clinic definitely crossed a line.

The tech who first told me the story said that they had tried to get permission from the husband since he was sobbing, but he said his wife hated the dog and made him promise to put it down. The tech who had actually taken the dog no longer worked there when I got there, but I was told that she thought that the husband didn't want to put it down, but felt he had no choice so she was following his intentions. Supposedly, he was relieved to hear the dog had not been put down.

I worked there and was told the story about 2 years later.

 

[dyachei]

And sometimes (though not always) it's true.

There are some animals for whom I would agree to euthanize even if in okay or manageable health if the owner were to die, there wasn't a suitable home for the pet, and it was the owner's wish.

oh for sure. but usually, it's the owners making assumptions

 

[Minnerbelle]

oh for sure. but usually, it's the owners making assumptions

Oh yes, I know. It's always like some crazy b**** who wants to euthanize for some stupid reason that is unlikely to be a euthanizable offense (just owner's lack of intent to do anything about it). And they don't want to find another home. Oh no no no, this cat/dog couldn't possibly live without me!

 

[LadyOtheFarm]

And sometimes (though not always) it's true.

There are some animals for whom I would agree to euthanize even if in okay or manageable health if the owner were to die, there wasn't a suitable home for the pet, and it was the owner's wish.

I get this. We actually did a couple of these at the first clinic I worked at. Often we helped the owner look into alternatives and at least twice the owner signed paperwork attached to their will that basically said "If Fluffy's illness gets worse and/ or no home can be found that meets his needs by this date, then I request the humane euthanasia of Fluffy."
We also put down a dog to be buried with her owner. Both were blind, diabetic and had mobility problems. The dog could have lived maybe a year or so more but the owner had scheduled end of life hospice. (They were weaning her off O2 and increasing pain meds while stopping all other medications. She was expected to last no more than 2 days.) She came in with her dog, both on pain meds and in pretty fine spirits and had us all say goodbye. We sang to the dog and all pet her and hugged mom like they were going on a trip. There were a lot of smiles and a ton of tears. She actually made it kind of beautiful and you could tell they were best friends. That dog's fat little butt and tiny curly white hair covered mini poodle tail wagged all the way to the end...

Ok, I'm crying again. It was very sweet, I don't know if I expressed that well. This dog had never been away from her mom. When mom got taken in an ambulance, the dog had permission to ride with because she had followed the ambulance to the ER before. Ugh, happy sad.

 

[Skimble]

Not sure if I believe this, but if it were true they don't deserve to be in business. That is ridiculous.

Honestly, if I were you I wouldn't believe it either, but I saw this women more than once a month for 6 years. I knew her well enough to be invited to her home, she bought me Christmas gifts and was possibly more excited than I was when she found out I was accepted to vet school. That may make her sound like a super nice person, but she was extremely high maintenance and you did not want to be on the receiving end of her anger.

When she told us the story, I was shocked that she was asked to pay, and told her I was surprised that she did. She responded that she was in shock, so she paid and left and didn't really think about it until later, which, I understand. Her husband told us the same story at a different time. I suspect the practice owner/vet had no intention of charging her and there was poor communication to the receptionists about it. After she paid, I'm not sure there is much the vet could have done. Sure they could have refunded her the money, but I also understand not wanting to contact her (and I do mean her specifically) and say "not only did we screw up and accidentally kill your healthy pet, we also accidentally charged you for services that we shouldn't have because of the original error." She never reported the incidence or attempted to do anything about it, mostly because by the time she recovered from her shock and realized how terrible the entire situation was handled, enough time had passed that she didn't feel it was appropriate to seek legal action. Which, I also understand due to first hand experience with a terrible mistake made by my son's daycare when he was very young. Severe shock can cloud rational thought.

 

[battie]

There was a vet (in Texas I think.. maybe Fort Worth?) who would keep patients alive who were supposed to have been euthanized by owners request, or even by his own recommendation. He would take them in the back and "euthanize" them without the owners being present. Instead of euthanizing, he would use them for his own research, keeping them alive for who knows how much longer... There are some twisted people on this planet!

The vet your talking about kept a black lab alive after the family signed for it to be euthanized. He used the lab for blood transfusions for a year or so before a tech reported him to the state. If you look around here, we talked about that case at some point

 

[hazelmoo]

The vet your talking about kept a black lab alive after the family signed for it to be euthanized. He used the lab for blood transfusions for a year or so before a tech reported him to the state. If you look around here, we talked about that case at some point

Yeah, we talked about it a lot when it happened at my clinic! Apparently, another woman came out in Dallas suing him for the same thing involving her old chihuahua and "medical experiments". Don't know all the details, but I'm surprised he only got a suspended license and wasn't barred from practicing since he has some serious ethical issues...

 

[CalliopeDVM]

There was a vet (in Texas I think.. maybe Fort Worth?) who would keep patients alive who were supposed to have been euthanized by owners request, or even by his own recommendation. He would take them in the back and "euthanize" them without the owners being present. Instead of euthanizing, he would use them for his own research, keeping them alive for who knows how much longer... There are some twisted people on this planet!

I think that's Lou Tierce (https://www.google.ca/search?q=texa...=cr&ei=Lxo-VtP4GYGR-QHZ96voAg#q=dr+lou+tierce)

 

[hazelmoo]

I think that's Lou Tierce (https://www.google.ca/search?q=texa...=cr&ei=Lxo-VtP4GYGR-QHZ96voAg#q=dr+lou+tierce)

Yep, that's him!
Just reading some of that stuff makes me ill. Texas has come under some bad light with veterinarians lately it seems like.. First him, then Kristin Lindsay. Ugh

 

[CalliopeDVM]

Yep, that's him!
Just reading some of that stuff makes me ill. Texas has come under some bad light with veterinarians lately it seems like.. First him, then Kristin Lindsay. Ugh

It's pretty unbelievable that they pulled her license, but he only got his suspended. I think it might be because she bragged about what she did?

 

[WildZoo]

It's pretty unbelievable that they pulled her license, but he only got his suspended. I think it might be because she bragged about what she did?

Oh wow she actually lost her license? I didn't know that.

 

[hazelmoo]

It's pretty unbelievable that they pulled her license, but he only got his suspended. I think it might be because she bragged about what she did?

Oh wow she actually lost her license? I didn't know that.

I agree.
She lost her license in TX but could still get it in other states from what I understand. I think how she handled it had a lot to do with it, especially since it got sooooo much media attention.

 

[Skimble]

Oh wow she actually lost her license? I didn't know that.

Yes, but she's trying to appeal the decision.

 

[ThePetDoctor]

We had a client try to sue us for referring her dog out to a specialty clinic and she wasn't satisfied with the care the dog received there given the large sum of money she spent. She tried to sue the referral clinic too. The judge dropped the case against us right away and she lost the case against the referral clinic too.

Another client told me a story about how she boarded her new purebred kitten at her vet and when she returned to pick it up they informed her a tech had mistakenly euthanized her kitten and then they still charged her for the boarding prior to the kittens untimely death!

This is crazy to me! I can't wrap my head around how one can mistakenly euthanize a kitten that was boarding. Every hospital I've been in has boarding separate from treatment animals. I just don't understand 😵

 

[Skimble]

This is crazy to me! I can't wrap my head around how one can mistakenly euthanize a kitten that was boarding. Every hospital I've been in has boarding separate from treatment animals. I just don't understand 😵

We occasionally boarded animals in our treatment room. Particularly ones with health concerns like diabetes and epilepsy. Apparently the kitten was boarded in the treatment room because it was a cute kitten and the techs wanted to keep an extra close eye on her.

 

[hazelmoo]

We occasionally boarded animals in our treatment room. Particularly ones with health concerns like diabetes and epilepsy. Apparently the kitten was boarded in the treatment room because it was a cute kitten and the techs wanted to keep an extra close eye on her.

That is so sad :'(