Hot on the heels of my malpractice insurance fiasco comes this timely post. Here I detail the top ten mistakes seen in vet practice (yeah, we vets do stupid stuff sometimes):
1-Forgetting to take out the IV catheter when pets go home: This is common (three or four times a year for us), though not so much since we started including CATH OUT! checkboxes on our patient’s cage cards.
For the record, I know firsthand this happens in human medicine, too. I remember distinctly after bringing my 85 year-old great aunt home from the hospital that I’d had to remove the IV the hospital left in. The most memorable bit of this story is that before I extracted it, she’d been calling her doctor claiming they’d left her “VCR” in. I got a kick out of that one.
2-Leaving the thermometer in: Yes, really. Though I’ve never been known to do this, almost everyone has at least one story about broken thermometers in backsides, clients threatening to sue over mercury poisoning, surprise thermometer-laden stools and other decidedly un-funny rectal temp occurrences. Other than a slew of broken digital thermometers lost to racehorse hooves during my stint in school at Penn’s New Bolton Center (you try taking the rectal temp of a spoiled, 1,200 pound two year-old) I have no great stories for you on this front.
3-Close-cropping toenails: OK, so this one’s boring, but the bloodbath that can result from an overtrimmed claw means possible head trauma for our squeamish, faint-prone clients. Such a tiny transgression is not without its ripple-effect.
4-Cutting the patient while removing bandages: Again, one disaster I’ve never managed but which one bifocal-sporting colleague admits to frequently stressing over—especially when it comes to cats (even when using bandage scissors!). Tissue glue works wonders for this, by the way—as does honesty. No client wants to be surprised by evidence of your accidental slice before you tell them about it.
5-Too-tight bandages: Now, this is an understandable one. In many cases, we’re stuck bandaging swollen spots. We sometimes make it a tad tighter in places with the judicious understanding that the swelling will subside over the next 24 hours. But not all estimates work out. And then there’s the vagary of limb movement and bandage sliding and chewing to consider.
6-Mis-labeling the meds: Wow, now that’s a killer—potentially, anyway. Though we typically train everyone in our hospitals to learn how to check standard drug dosages, it still happens.
7-Just plain forgetting to do something while the pet was under anesthesia: Just today, I realized I’d committed this sin (which occasioned this post, of course). I hadn’t removed a retained puppy tooth from a one year-old dog’s mouth during her spay. Oops!
Sure, it’s in the chart. Sure, it’s ultimately my responsibility if someone’s ears didn’t get a thorough flushing. But an extra tooth? Sheesh! That needs to come out! And this one’ll be on my dime for sure—as it should be.
I know ya’ll hate declaws but I couldn’t resist telling you about one who’s left dewclaw got left behind. That’s an asymmetrical double-oops!
8-Whose poop is whose?: On a busy day it’s all over the place. (The stool, that is.) The last thing you want is to try figuring out who had the hookworms…after the fact.
9-Forgetting to place the e-collar immediately after surgery: Murphy’s Law dictates that these are the pets most likely to tear out their sutures.
And finally…
10-The dreaded syringe malfunction: I actually read about a lawsuit currently pending on this issue. The aggrieved owner is suing the vet for pain, suffering and an emergency room visit after the euthanasia solution got into her eye after a syringe malfunction during the procedure. For the record, something like this has happened to me exactly twice in twelve years of practice.
One time, the thickness of the solution, the slipperiness of the needle tip and too much pressure on my part made for a barbiturate shower. Luckily the owner wasn’t present and the only one personally affected by the solution was me (and it didn’t hurt my eyes a bit but it sure tasted awful nasty). I now use luer lock syringes for all euthanasias.
The second time, my syringe actually came apart during a sizable blood draw, spilling what appeared to be buckets of blood on the tile floor below. The owner didn’t faint but she didn’t wit around for another blood draw, either.
Got more? Give ‘em up!
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Ooo ooo, how about spaying a tomcat?
Megan February 27th, 2008 10:34:00 AM
Megan: A tomcat would be tough but I've known of more than one neuterd stray to hit the table and get pseudo-spayed. It happens.
Dr. Patty Khuly February 27th, 2008 10:43:00 AM
The things you are listing are benign compared to what I read about, when I read state vet board decisions from all over the country.
Here are some ACTUAL mistakes that have been made in veterinary practices in the past 5 years, the first one -- made on MY cat.
1. Leaving your patients with an UNLICENSED UNSUPERVISED person who happens to be your son, who is NOT a vet tech, and who "hasn't given an insulin shot" in years, and who subsequently uses a TUBERCULIN syringe instead of an insulin syringe, resulting in a MASSIVE 30 unit overdose.
2. Letting unlicensed unsupervised assistants give insulin (different case), and they end up using a U-40 syringe to give U-100 insulin. (this was done to someone else's cat).
3. Ligating both ureters during a spay (this has been done MANY times by MANY vets)
4. Allowing an unlicensed, unsupervised "assistant" to compound medication, resulting in a fatal overdose (real story).
5. Giving a cat who has pleuresy from fluid overload and is "recumbant" a dose of lasix and then leaving her unattended overnight.
6. Keeping an elderly dog under anesthesia for 3-4 hours to pull every tooth in his mouth without informing the owners you were going to do that. (he died).
7. Leaving the drug cabinet unlocked.
8. Persisting in a diagnosis of toxicity due to ingestion of shampoo YOU prescribed when the owners told you no shampoo was ingested and the dog is a Shetland Sheepdog who came in with a visible tick bite and unexplained limping followed by increasingly severe symptoms.
9. Giving an injection of pentobarbitol (diluted) directly into the abdominal cavity for "sedation" or pain (not for euth). This destroyed this animals internal organs.
10. Putting two dogs together in one cage when the owner has told you not to.
11. Prescribing NSAIDS to a pet who is in kidney failure.
I could go on, but you get the drift.
Your previous post from yesterday makes it sound like there is so much UNWARRANTED claim of vet mal going on, but I can tell you, that there are SCORES of completely WARRANTED claims of vet mal -- and nothing is done about it. These vets typically are fined VERY little and given "stayed" suspensions.
Stefani February 27th, 2008 12:00:00 PM
Have you ever had cases of animals interacting with each other negatively, like fighting or a predatory response? I've never heard of an avian-only vet, so the vets I see have cats and dogs around, not always in cages, and I'm often paranoid one of them will get at my bird somehow, like if the door to the exam room is opened and the bird slips out or the other animal in.
zandperl February 27th, 2008 12:58:00 PM
Stefani: I'm sure there are many well-warranted cases of malpractice that are never ever reported. How many intra-cardiac sticks did it take before the Tennessee butcher got caught?
Problem is that from the POV of one vet who knows lots of super vets it's harder to imagine malfeasance among my friends. And I've seen them suffer after being sued for *no good reason.* They won their cases handily after the judges looked at things clearly but they still spent months of stress and loads of money defending themselves.
It's not that I'm making excuses for the many truly indefensible offenders. I know they're out there and I assure you that *all vets* have a vested interest in getting them gone from this profession.
Dr. Patty Khuly February 27th, 2008 01:02:00 PM
It's too bad patients can't sign a binding-arbitration clause with a vet practice. (I'm guessing it would prove difficult to implement / enforce anyway)
When I have a vet I've worked with for a while and trust I'd be happy to sign such a thing to keep litigation costs (and consequently my costs) under control.
Larry February 27th, 2008 01:57:00 PM
zandperl,
Our vets have a dogs on leash, cats in carriers policy to keep everyone safe and happy. My dogs' vet doesn't handle exotics, but restraining our friendly neighborhood predators seems like it should keep everyone safe in a mixed practice. Dogs with aggression problems (human or animal) can also be muzzled as an extra precaution.
AdoptedAPBTs February 27th, 2008 02:07:00 PM
The only one I've ever encountered as a client is the nail clipping gone awry. Quick application of treats and kisses solved the problem in the eyes of the dog.
I wasn't particularly upset - it happens, it's not fatal, the vet was very apologetic and by the end of the visit, the dog had already forgotten that it happened.
Cindy February 27th, 2008 03:10:00 PM
Regarding failure to remove IV caths, one place I worked for had us use neon orange or neon yellow coflex for catheter wraps and blue for all other bandaging purposes - we caught more that way before they hit the door.
Mixing up fecal samples has happened a few times w/me, too. We've been using a centrifuge for quite some time, though, and the samples go into a clear tube that's a little less ambiguous than a fecalyzer container - you can at least tell what color the feces was, how much was put in there, etc.
Putting blood samples in the wrong tube: sometimes you forget that you need to run a heartworm test with that blood too - after you put it into a serum separator tube, etc.
I did work for a veterinarian who once removed the thyroid from the wrong cat. There was an almost identical cat in the kennel next to the hyperthyroid kitty and the tech forgot to double-check the charts. Then I guess the vet didn't notice she was cutting on the wrong cat. Pretty crazy. Lucky for the vet, the owner of the de-thyroided kitty didn't sue...but she could have, and it would have been warranted. I think that's the most serious transgression I've witnessed.
My own confession? I frequently forget to snap Snap tests. Even though the directions say to put the test on a flat, level surface, I've taken to carrying them with me (as parallel to the ground as possible) as I go on w/my tasks so I don't forget to snap the darn thing!
anna February 27th, 2008 03:50:00 PM
Z-at the vet I worked for they had a case where someone let their toy poodle "go say hello" (without GSD owners permission) to a german shepherd in the waiting room and got killed when said GSD picked up the dog and shook it like a toy. Does that count?
I've never really understood why anyone would let their dog go say hello to another without permission. ESPECIALLY in a vet waiting area where the dogs might be contagious.
Marie February 27th, 2008 04:59:00 PM
I know doctors don't remove IV's either. I had to take my own out after being discharged.
As for vet's, we used to take our poodle to one that did grooming as well. During the grooming, as he was working on her face, he shaved out her eye!! Then, said that he would put her to sleep and reimburse (sp?) for a new dog.
-.-
we don't use that vet anymore...
ashleigh February 27th, 2008 06:01:00 PM
The dreaded syringe malfuntion - we've had this problem at home. Nothing like your cat walking off with the needle still in him - sometimes the liquid goes in, sometimes it's on his fur. Next box of syrings will have to come from the vets - they weren't the screw ones but at least the needle didn't pop off so easily.
Jenny February 27th, 2008 07:08:00 PM
Ashleigh, that is horrible! As a groomer, I can't imagine how an eye could even be shaved out! Your poor dog. :(
I had an elderly cat who I had to give frequent sub-q fluids to.... more than once I realized I'd poked too far when the fluid came spurting out the other side of her scruff! ;/
clover February 27th, 2008 08:12:00 PM
Heh. The sub-q "poke through the tent to the other side" happens to me as well on occasion.
At least the fix is easy: just pull the needle back a little so it's still under the skin and doesn't poke out.
Xslf February 28th, 2008 02:51:00 AM
ashleigh i am SHOCKED by that! im a groomer too and though we see our fair share of matted-to-the-skin dogs, i've never heard of an eye being SHAVED OUT. that's terrible!
charity February 28th, 2008 01:38:00 PM
Ashleigh, your story is truly terrible. I was a proffessional groomer for 10 years and never came anywhere close to something as terrible, no matter how matted the dog was. It sounds like he was as rough as he was callous !
I have difficulty trying to think *how* he managed to actually do it, I can only imagine he stuck the corner of the blade into the eye somehow. Terrible, I shudder to think about it. Did you end up having her PTS, or did she survive (minus the eye ?), what was the outcome ?
Alison
Alison Woolley February 28th, 2008 02:18:00 PM
One week I accidentally cut two patients while cutting off IV bandages, both times using bandage scissors. In both cases the patients were still pretty sedate and their skin was very elastic. I felt awful! But yep, tissue glue and blunt honesty saved the day.
Everyone cuts toenails too short once and a while; it comes with the territory.
I have witnessed the euthanasia-solution shower that occurs with non-leur lock syringes. At my work the only non-leur lock syringes we have are tuberculin syringes or catheter tips; the rest all lock!
And I can totally relate with Anna about SNAP tests; I will usually forget to snap one about every two months; it's always on the patients that were hard to draw blood from! Augh!
Ones I recall:
A Dr. meant to give a Centrine injection, and was puzzled when the dog became very sedate. He had picked up the Telazol bottle by accident! Fortunately the dose was within a safe range.
Another: a tech asked her assistant to give a patient an ampicillin IV injection. The assistant, not knowing the difference (and not taking the initiative to ask), gave an amoxicillin white suspension meant for subcutaneous injection IV. Fortunately, the patient did not have any reaction.
And once a tech gave a cat a canine DHPP. Again no reaction occurred, thankfully.
Kathy H. RVT February 28th, 2008 08:37:00 PM
My regular vet had mostly retired (he was only seeing old clients, like us) by the time my elderly dog needed to be euthanized. I decided to have him perform the euthanasia because she was very comfortable with him and liked him.
Little did I know, he had Parkinsons. It wasn't terribly obvious until he went to insert the syringe, and she struggled, and he almost landed the shot in me! Awful experience. I am still sad that my girl's last memory was one of her owner totally terrified of being euthanized. (My dog and I weighed about the same amount - I guessed that it would have been as effective on me as it was on her)
Needless to say, when we brought a new puppy home, we also found a new vet. While I loved our old vet and his common sense approach to veterinary medicine, I am also happy that he retired.
Erin February 28th, 2008 08:50:00 PM
Multiple pets and over 30 years, sure there has been booboos. All my recollections seem insignificant to my more recent '06 past. Not privvy to the front lines, I just wish that mistakes were acknowledged,apology offered, and corrected--no matter how trivial (or not) to the clinic. It makes for hard feelings, when it (mistake) is assumed it wasn't noticed, covered up, or worse, denied. Clients don't expect a walking encyclopedia or extra sensory perception, just plain honesty.
****this is not applicable to FRAUD, cruelty, & financial scams. Where are all these malpractice cases??? Most states consider a pet no more than a "toaster", legal fees for the client to bring suit, would more than likely not be recouped by any damage awards---not too mention "non-economic" is not even allowable for a broken or dead toaster.
Anyways,I digressed. A younger sibling of mine also had a much needed life-saving surgery back in '06. After a week or so, a distinct white piece of plastic partially protruded through an unhealed wound. Our family, including my sibling had lots of yucks, proclaiming the surgeon lost his "coffee spoon" ----it wasn't, of course, but added some humour to a stressful time. Drs. ----anyone have an item accounted for, after an open surgery???
Barbara A. Albright February 29th, 2008 12:12:00 AM
My cat was savaged by a dog, and the vet had a look at him, and sent him home with antibiotics. When I checked on him later I found a hole, in his side, and could see his intestines through it. The vet missed it. I took him back and she put him under, opened him up and checked if there was any internal damage. There wasn't luckily, but she can't have been looking too hard the first time round.
Robin March 5th, 2008 06:47:00 PM
What about taking your young healthy dog in for a neuter surgery and never having surgery and you beloved dog dies. You as a client are lied to and treated horrible and as devastarted as I was then left to research what happened to my dog completely on my own. He was given a Horse & Cattle drug without any informed consent. Then my dog was not taken to have a necropsy untill the next day after telling me that I had changed my mind. How could I have changed my mind if they didn't talk to me? I was told that I over fed my dog. He had been withheld food & water for almost 14 hours. Then when that didn't work they told my husband that he was congested. They why was he preped for surgery? The lies just kept coming. He was allergic, the necropsy showed that none of this was true. I believe that they weren't going to take my dog at all, but when I called to see what was wrong, they suddenly appeared at the state lab with my dog. I was ignored and had to find out on my own that the clinic hqad used a drug that was not recommended for dogs. This is WRONG. I filed an FDA Adverse Report and the drug co also but not the vet or the clinic. I know this is not manditory but it should be. I have been left traumatized and devastated. My dog was unreplacable and very valuable and not in the dollar sense of it. The damage to me is undoable.
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