FINAL DECISION AND SECTION 43 STATEMENT TO THE VETERINARY COUNCIL BY THE COMPLAINTS ASSESSMENT COMMITTEE Dr B. CAC (Complaint by Mr A)

Transcription

1 FINAL DECISION AND SECTION 43 STATEMENT TO THE VETERINARY COUNCIL BY THE COMPLAINTS ASSESSMENT COMMITTEE Dr B CAC (Complaint by Mr A) Mr A Dr B C Ms D E Complainant Veterinarian complained against Name of pet Practice Manager of E Dr B s and D s place of employment Names and locations have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no relationship to the person s actual name. Summary 1. The Complaints Assessment Committee ("CAC") of the Veterinary Council of New Zealand has investigated the above complaint. 2. Pursuant to Section 43 of the Veterinarians Act 2005 the CAC has reached a final decision as set out below. The Investigation 3. The CAC considered information from the following sources: a. Mr A s dated 28 February 2012 b. Dr B s response dated 20 April 2012 including the following attachments i. Copy of patient clinical history (5/2/12) ii. Copy of Authority for Euthanasia signed by Mr A (10/2/12) iii. iv. Copy of the original complaint letter from Mr A to Dr B (10/2/12) Copy of a fax received from Mr A (10/2/ pm) v. Copy of the faxed letter sent by Ms D, E s Practice Manager, to Mr A (10/2/ pm) vi. vii. Copy of a fax received from Mr A (10/2/ pm) Copy of an sent by Mr A (13/2/ am) viii. Copy of the reply sent by Ms D to Mr A (13/2/ pm) ix. Copy of the second sent by Mr A (14/2/ am) 1

2 x. X-rays of C s fractured leg. Background based on the Mr A s dated 28 February Mr A was the owner of a cat, C, who had been his pet for over ten years. 5. Mr A advised that: a. At about 4 am on 5 February 2012, accompanied by his son, he took C to E, because the cat s leg was broken. The vet on duty was Dr B. b. Mr A was told that C s leg would need to be amputated but that the cat could lead a normal life with only three legs. Mr A was informed that the cost would be about $800. Mr A told the vet he was on an invalids benefit. c. Because it was a holiday weekend, Dr B needed to find someone to help her x-ray C and told Mr A to phone her back later for an update. d. When Mr A phoned back, Dr B told him that the damage was worse than she had thought, and C s hip was damaged. Dr B said she could amputate the leg, but the other leg could become dislocated and C wouldn t be able to walk. Mr A and his son returned to the E to say goodbye to C before the cat was euthanised. Mr A was present when C was euthanised and noted that it took several injections. e. After Mr A returned home and discussed the situation further with his son, they both came to the conclusion that C was euthanised because Dr B did not have confidence in Mr A s ability to pay the $800 for C s treatment. f. In order to find out if this was the case, when Mr A returned to E on Thursday, 9 February, to settle the $208 bill for C s care, he requested the cat s x-ray for a second opinion. He was told that he had no legal right to the x-rays. g. The next day, Friday, 10 February, Mr A sent a fax to the vet asking for an explanation. When he heard nothing, Mr A sent another fax saying that, unless he heard back by 4 pm that day, he would lodge a complaint with the Veterinary Council of New Zealand. Within minutes, Mr A received a very apologetic reply. h. Mr A sent another fax asking for more information, including which law prevented him being given his cat s x-ray. He received a phone call from Ms D, the practice manager for E, in response. Mr A told Ms D that his lawyer did not know of any law that prevented the handing over of the x-ray, and he suggested that it might instead be company policy. Ms D agreed that it probably was company policy rather than a law. 2

3 i. Mr A has now been told by the vet that he can ask another vet for a second opinion and that the veterinary clinic will forward the x-ray on to that other vet as soon as they are told who it is and where. But he no longer trusts the veterinary clinic, does not believe that an x-ray exists and does not know if he can trust another vet because they may protect each other. j. Mr A indicated that he signed a waiver for C to be euthanised, but feels it was based on lies. k. Mr A is also intending to make a complaint to the Human Rights Commission that he was discriminated against because he was on a benefit. The Complaint 6. Mr A s complaint is that: a. his cat, C, was wrongly euthanised rather than treated for a broken leg, because the vet thought Mr A was not able to pay the $800 for C s treatment; b. he was lied to about the x-ray of C s leg; and c. he was told he had no legal right to the x-ray. Dr B s Response 7. The sequence of events as described by Dr B correlates with those described by Mr A. 8. Dr B advised as follows: C s treatment a. At 5.15 am on Sunday, 5 February 2012, she was called out to see a 9 year old British Blue cat named C, owned by Mr A. The cat was suspected of having been hit by a car. b. On initial assessment, C was not able to walk and in a great deal of pain and distress. He had what appeared to be an open, multiple fracture of his left tibia and fibula hind leg bones and a de-gloving skin wound over the hock. Dr B s initial treatment of C included high dose morphine, antibiotics, subcutaneous injection of fluids, wound cleaning, emergency dressing and a sling-splint to stabilize the fracture until x-rays could be taken. c. Dr B told Mr A and his son that the leg injury was very serious and that it would almost certainly require amputation. Dr B also offered Mr A the option of referral to Massey, which was declined. 3

4 d. Dr B gave Mr A an estimate of $600 - $800 for the surgery alone, if it was a straight forward amputation that could be done during working hours; but Dr B also qualified this estimate by explaining that she would need to assess the damage to C with x-rays, which could result in a change to this plan and cost. e. Mr A said he would not be able to pay for the surgery all in one go, and Dr B reassured him that a finance arrangement could be organised with the accounts manager during the week, because the surgery was necessary for animal welfare reasons. f. Dr B called in another vet to assist with x-rays. In examining the x- rays, Dr B found that, in addition to the left leg fracture (the left tibia and fibula were shattered), the right hip joint was also dislocated. Further x-rays could not be taken while the cat was conscious, because he was in too much pain. A pelvic fracture and femoral neck (hip bone) fracture could not be ruled out at this point. Dr B s opinion was that any surgical prognosis would be guarded and a full recovery could not be guaranteed; however, immediate action was required to alleviate C s suffering and to give the best possible chance of a good outcome. Dr B asked her colleague to view the x- rays and he agreed with Dr B s prognosis. g. Dr B phoned Mr A to update him and explain the situation. Dr B explained that C s injuries were more serious than first thought, as the right hip was dislocated and there was a possibility of pelvic fracture. She also explained that, because C was in a lot of pain and distress, the cat would require general anaesthesia for further x-rays and surgery that day, if treatment was attempted. h. Dr B warned Mr A that the cost would be higher than the initial estimate, because the surgery needed to be done out-of-hours due to the emergency nature of the surgery and it being a public holiday weekend. Dr B also explained that the surgery would be less straightforward and there could be ongoing costs associated with a potentially prolonged and complicated recovery. Dr B advised she made it clear to Mr A that she was willing to try the treatment but that she could not guarantee a good outcome. i. C could not be adequately stabilized in his current condition and could not be left as he was. Dr B stated that Mr A was obviously upset, and Dr B asked him if he would like to come down to the clinic for a face-to-face discussion before making any decisions. Mr A declined this offer and said he would discuss it with his son. About 15 minutes later, Mr A called and informed Dr B that he and his son had decided it was best to have C put to sleep. j. Mr A and his son both signed a Euthanasia Consent Form after the process was explained to them. Dr B had both sign the form, because Mr A explained when he first arrived at the clinic that he suffers from Multiple Sclerosis and Alzheimer s and has trouble remembering even very recent events. 4

5 k. Mr A and his son were present for the euthanasia. Dr B attempted to get access to a vein while C was in his cage, to avoid moving the cat further; however, it was not possible, so C had to be moved. The cat was still distressed and in pain despite pain relief. Dr B was working alone, so C was heavily sedated with Medetomidine prior to injection of the euthanasia solution, to make the cat more comfortable. Dr B explained what she was doing at every stage, so Mr A and his son both had the best possible understanding; however, they were both obviously upset. Dr B suspects that it was this chain of events that Mr A referred to as the multiple attempts at injection or botched injection. l. After C was euthanised, Mr A and his son took C home for burial. While they were both understandably upset, they reminisced about the great life C had led and what a great companion he had been. Dr B, Mr A and his son also spent a few minutes together interacting with some of the clinic s other inpatient animals. When Mr A left, he seemed in better spirits. m Dr B notes that Mr A feels discriminated against for financial reasons, but states that this was not the case and that at no stage was Mr A told the clinic would not treat C for financial reasons. Dr B states that she was very clear with Mr A that the treatment could get considerably more expensive than initially thought and that Dr B could make no guarantees of successful outcome at the end. It was Mr A s decision to make the choice with the information Dr B provided to him. Mr A chose, after some deliberation, to have C put to sleep, and at no point subsequently did he make any indication that he had changed his mind. Request for C s x-ray n. Five days later, on Friday 10 February, Dr B received a complaint letter via fax from Mr A. It was then that Dr B was informed by the Practice Manager that Mr A had come in during the week wanting C s x-ray. o. Dr B was told that one of the vet clinic nurses had told Mr A that it was not possible to give him the original x-ray, as it was part of the clinic case notes. p. Dr B was also informed that a faxed letter was sent to Mr A by the Practice Manager that Friday at noon stating that the clinic was more than happy to forward the x-ray to a vet of Mr A s choice for a second opinion, but this offer was not taken up. q. Dr B states that she was not informed of Mr A s request for the x- ray at the time of the request, and that had she been informed, she would have willingly organised a copy of the x-ray for Mr A. r. Dr B also notes that there has been some in-house discussion with support staff and the senior practice veterinarians regarding E s 5

6 practice policy surrounding animal x-rays, so that in future client requests for x-rays will be handled differently, and clients will be supplied copies of x-rays on request at cost. Response to Mr A s communications s. When Dr B received Mr A s complaint letter via fax on Friday 10 February, Dr B was instructed that management would handle the complaint fully, and Dr B had no further contact with Mr A. t. Dr B was informed that the three faxes that Mr A referred to in his complaint, which were, in Mr A s opinion, not responded to promptly by the clinic, were sent within a few hours of each other on that Friday morning. u. The Practice Manager faxed a letter to Mr A that Friday at noon (see paragraph p, above). When she received a third fax from Mr A, the practice manager told Dr B that she also followed this up with a phone call to Mr A, during which he told her that she had given him something to think about and that the clinic would hear from him the following Monday if he was to pursue a complaint. Dr B understands that the clinic heard nothing further from Mr A until being notified by the Veterinary Council of his complaint. CAC Considerations 9. The CAC appreciates that Mr A is understandably upset at the loss of his much-loved cat C. 10. Dr B s response to Mr A s complaint was full and professional, and there was useful additional patient history and clinic material attached that supported her comments. 11. The CAC viewed the x-ray provided by Dr B. The x-ray was labelled and identified as being C A. The x-ray showed a severely fractured tibia and fibula of one back leg and a dislocated hip involving the other back leg. Both back legs were sufficiently injured that the outlook for C to recover and have an acceptable quality of life was very guarded. In light of this x- ray, Dr B s treatment decisions and judgements were considered by the CAC to be appropriate. 12. Veterinarians are obliged to consider the cost of treatments and include this in their discussions with owners when obtaining consent for work before it is undertaken. Veterinarians are not obliged to undertake work that the owner is not able or willing to pay for. Dr B carefully considered the cost of the treatment and intervention and involved Mr A and his son in discussions when developing the treatment plan. The plan took into account Mr A s instructions and financial limits. In the CAC s opinion, Dr B acted appropriately in this regard, by providing as much information as possible to Mr A for him to make an informed and considered decision about C. 6

7 13. X-rays taken for the purpose of reaching a diagnosis are owned by the veterinarian. Veterinarians have a professional obligation to retain x-rays as part of their patient s medical record. However, x-rays can be released to another veterinarian, or to the owner if a copy can be made. 14. Section 4 of the Code states: a. Veterinary medical records document the veterinary services provided to clients over time and chronicle the various treatments given to animal patients. These records are an integral part of veterinary care and are a legal requirement in order to record the use of restricted veterinary medicines. Medical records include radiographs or other imaging records, laboratory results, in patient treatment summaries, consent forms and any other ancillary records relevant to the case history. b. Veterinary medical records are owned by the practice owner and must be retained as required to comply with legal requirements. k. In the interests of openness and transparency and in order to comply with the Privacy Act 1993, veterinarians must provide clients access to their animal's records on request, unless there are justifiable legal reasons not to. Where the practice incurs costs to duplicate records, those reasonable costs can be passed on to the client in order for them to obtain their copies. 15. The CAC accepts Dr B s statement that she was not informed of Mr A s request for C s x-ray at the time of the request, and that had she been informed, she would have willingly organised a copy of the x-ray for Mr A. The CAC also notes that, as a result of Mr A s complaint, E has reviewed its practice policy surrounding animal x-rays, so that in future client requests for x-rays will be handled differently, and clients will be supplied copies of x-rays on request at cost. Provisional Decision 16. Dr B and Mr A were both provided with a copy of this decision in provisional form and given the opportunity to comment. 17. Dr B had no further comment to make about the provisional decision. 18. Mr A responded raising several matters. Each of these matters was considered by the CAC in detail in reaching the provisional decision. Consequently the provisional decision remains essentially unchanged. Final Decision 19. The CAC has given careful consideration to all the information received, including the responses to the provisional decision. 7

8 20. The CAC does not believe there are grounds to consider that Dr B has acted outside her level of clinical competence or that she should be referred to the Veterinary Council for competence assessment. 21. The CAC also has found no evidence that Dr B has acted unethically or dishonestly and does not believe there are grounds to require disciplinary action. 22. The CAC believes that this case can be closed and no further action needs to be taken. 8