Report of Malpractice Suit May Portend Fewer Surgeries by non-Specialists

Thankfully, the suit does not involve me. But the suit deserves to serve as a wake-up call for many veterinarians. When I work as a...


Thankfully, the suit does not involve me. But the suit deserves to serve as a wake-up call for many veterinarians.

When I work as a veterinarian, I work as a general practitioner. I focus on family practice and emergency and critical care medicine. This means that I have experience in these areas, but I do not have advanced training or certification in them. Veterinarians with advanced training and certification are specialists, not general practitioners (note that no veterinary family practice specialty exists, although that hopefully will change soon).

Veterinary medicine is different from human medicine in this regard. Practicing MDs are all specialists. General practitioners (also known as primary care practitioners) are trained to be, as the name implies, the primary doctors people see. They treat many ailments and develop lasting relationships with their patients. However, when a patient has a problem that would be best solved by a specialist in surgery, ophthalmology, or dermatology it is part of a general practitioner’s job to refer the patient to the appropriate specialist. Primary care physicians in all but the most isolated areas do not perform major surgeries.

Veterinary medicine is trending towards this model, but we aren’t there yet. As a general practitioner, I am licensed to perform any medical procedure on any species of animal except one (the one treated by physicians)*. My license allows me to perform open heart surgery on a cow, brain surgery on a horse, and orthopedic procedures on mice.

More realistically, my license allows me to perform just about any imaginable surgery on cats and dogs. But that doesn’t necessarily mean that I should perform every possible surgery.

Some surgeries, most notably spays and neuters, are so common that almost every vet has done thousands of them. Every vet I know is qualified to perform these procedures.

But what about rare surgeries? Serious, major, surgeries. Surgeries such as correction of gastric dilatation-volvulus (bloat, an urgently life-threatening condition), emergency splenectomy (removal of the spleen), intestinal resection (removal of a portion of intestines, usually after an animal has ingested a foreign object), correction of cruciate ligament rupture, or perineal urethrostomy (a surgery that treats feline urinary obstruction).

A veterinarian who specializes in surgery has special training in these procedures. She has extra understanding of anatomy, blood flow, nerves, and advanced surgical techniques. She has access to state-of-the-art equipment. She has more experience in surgery than just about any general practitioner. A surgical specialist, honestly, will do a better job on rare surgeries than just about any general practitioner.

Yet many veterinarians do not offer the services of a surgical specialist when a difficult case comes up. They don their gloves, wade in, and use their universal license to take their best shot.

This is understandable in rural areas, small towns and any place where specialists are not available. But I live in a major metropolitan area. Specialist surgeons are on call 24/7/365. If an animal requires a rare and difficult surgery, one that I have performed only a few times or maybe never at all, is it malpractice not to offer to call in a specialist?

Probably. Here’s a malpractice case report, from the spring, 2010 issue of the American Veterinary Medical Association’s Professional Liability Insurance Trust newsletter.

Cat’s Surgery Doesn’t Meet Standard of Care

Dr. A was presented a cat experiencing repeated episodes of urinary obstruction. Dr. A performed a perineal urethrostomy. Soon after surgery, the cat was leaking urine and appeared to be in pain. The cat was referred to the university hospital (the specialists) for urethrostomy site stricture (narrowing of the surgical site), subcutaneous urine pooling (leaking of urine underneath the skin), and a urinary fistula (an abnormal opening or connection within the urinary tract). After a claims review, the PLIT-sponsored insurance carrier determined that the standard of care had not been met. Dr. A agreed to settle the case.

Failed to meet the standard of care is another way of saying committed malpractice. Dr. A’s insurance company said that the case was not worth defending.

I don’t know any details about the case. Maybe Dr. A was drunk when he performed the surgery. Maybe he had one hand tied behind his back. Or maybe all he did was perform a surgery that would have been better done at the university hospital that evidently was nearby.

I do, however, know one thing for sure. I’ll be calling in the specialists to perform perineal urethrostomies in the future.

*I should concede that there also are serious limitations on treating some species of wild life, especially endangered species.

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