Law Suits and Veterinary Medicine. What To Do When The Courtroom Comes Calling.

This blog was written with the help of a few friends. Two are lawyers, one a veterinary malpractice attorney.  These two dear friends also urged me to not publish this. It is "too personal and could  paint me in a precarious light." I have grappled with this for weeks. If you want to be anyone of merit you have to be true to who you are and go beyond what others will. I have had two brushes with the legal side of veterinary medical practice. Both were cases where I put my neck out to help a pet and their family and both were times that that family tried to make me responsible for their pets misfortune. 

**I must provide a disclaimer to remind everyone that I am NOT an attorney. Please seek an attorney  for assistance should you find yourself in the cross hairs of a legal dispute.

In an effort to help calm my nerves my husband reported that he had done a little research and the "average veterinary practice is served with a lawsuit once in every three years." Based on my 10 year veterinary tenure I would say that I am one lawsuit short of the average. Two suits in 10 years is two more than I would like to have faced. Both are behind me, and both have left me a little smarter, a little thicker skinned, and more determined than ever to help other vets when their 36 months run out.

Here is some of what I have learned when the suits meet the scrubs;

• You cannot tip toe through life trying to remain unscathed and off the radar. Pets are, and continue to become, integral parts of the family. With emotional attachment comes the responsibility to provide for both our patients and our clients. That, and,,, 

• We live in a crazy litigious society. No escaping it, but, please try not to become it.

• Be prepared for stormy weather. There are many wonderful glorious days of slaying illness, thwarting cancer, and soothing disease ridden pets so that they can live to see another day and with each bucolic day break lurks a thunderstorm somewhere on the horizon. It is life. There is good and, therefore, there has to be bad. Embrace both, they are life in its entirety.

• You will feel the problem cases coming. As soon as you do hit the medical record and start shoring up the records to cover your ass. If your handwriting is like the rest of us take a few moments away from the constant barrage of phone calls, barking dogs, and pestering people and sit down to read your record. Think about where the holes are. Fill in as much detail as possible.

• Relive every single detail of every interaction about the case and write it down as soon as you remember it. I walked around everyday with a notebook to jot down things I had forgotten, or neglected to tell my lawyer. I then sat down and assembled the whole case from day 1 to the final blow over a weekend. I drafted a 10 page recount complete with timeline, thoughts, and perceptions. I also provided guidance to my lawyer about my clients that I thought might possibly be relevant.

• Re-living and writing all of this was both painful and cathartic. I could put it on paper and walk away. Getting those interviews, meetings, documents, and thoughts out of my head and  in someone else's hands was the only time I could get some small degree of normalcy back.

• Never ever lie. That's the stuff that will get your butt nailed. You will in all likelihood have to swear on it in court. Start with the truth the whole truth and stick with it.

• Keep your trap shut. Once a client starts circling over head it is best to not try to minimize the damages by offering more fuel for their fodder. Shut up and get legal counsel.

• When the State Medical Board comes knocking take the same advice. They, in my experience, are gathering information to use against you. They expect you to talk but they will use it against you and they have the unfortunate ability of taking it out of context when you have no way of proving otherwise. "Yes" and "No" answers will serve you best. Should I ever have to face this again I will be using technology to my advantage. Get your lawyer on Skype, use Meerkat, or video tape the entire proceeding. For my case there were gross egregious errors and the guy who took my interview mysteriously disappeared to never be seen, or held accountable, again. I know it sounds ridiculous, but that is exactly what happened.

• Take the advice you give your new associates. When a challenge of a new unknown case raises the little hairs on the back of your neck, and you think that you cannot face the challenge, nor succeed, jump in anyway. Never let fear, doubt, or insecurity halt your ability to heal and help others. That is what we are trained to do. Do it, live it, and jump in!

• Never back down from a case that needs you and has no other option. In the end tis better to have tried and failed than to have never tried at all.

• Don't walk away and leave a patient to suffer because you allowed your fear and insecurities to govern your ability.

• Be prepared. Expect every amazing, devoted client who you believe trusts and cares about you as you cared for their pet to stab you in the back. It happens, that's why lawyers make so much more money than we do.

•  Don't be stupid enough to believe your demeanor and generous time provide compensation when a client gets pissed off. 

• Do have an exit strategy. For the day, the week, the month, and this career. Sometimes a light at the end of any tunnel is enough to keep trucking ahead. Even through the worst of times.

• Walk into every situation with a best and worse case scenario. Have a plan for each. We do this for every patient we see. Learn to do it for yourself.

• Never surrender your voice or your purpose. The State Medical Boards, the courts, the community can beat you up and strip you of years of your blood, sweat and tears, but in the end you walk away alone. In the end it only matters that you walk away alive and proud of the little tiny moments no one saw, paid for, or wrote Thank-You cards for. There is not one veterinarian who hasn't made another life better. 

• Protect yourself. Hire people who are versed, experienced, and prepared to go the distance. This includes your staff, your associates, your accountants, and your legal advisers.

• Relinquish the reins to those you hire to protect you, and to those who will care for and protect you while you cannot stand alone. Only greed, arrogance, and grossly negligent immaturity will destroy a career. 

• Go to sleep at night with a clear conscious, whatever that costs you. Write a check and settle when a court case looms ahead. 

• Break it down to simple unbiased mathematics. Hard and soft costs accumulate quickly. Disease doesn't choose a one year old puppy as a personal vendetta to a life just begun. How many times have we seen that? Life isn't fair. Step out of your emotional anger and apply science and math to a problem. 

• When the storm recedes and there is an the end, (there is always an end), you have to be able to face yourself tomorrow. 

• There is a winner and a loser. Money can buy you better odds, but ultimately fate, luck, and timing decide the narrow margins. Just accept that. 

• Don't undersell your day to day health and blood pressure. Try to take a few steps back, see both sides, and be the rational person in the room of people who lack both the desire to have a clear conscious and a moral compass. Somehow lawyers can be bipolar, vicious and blood sucking and still smile at both sides of the gallery with equal conviction and genuine probity. It is the antithesis of a veterinarian. If Themis holds a scale blindfolded there is a lawyer on one side and a vet on the other. Find a lawyer as opposite as you are to provide some semblance of balance. For my case it required a short bearded man with a devilish smile, witty sense of sarcasm, and a heavy hand delivered in a slow calm slicing hand shake.

• Call the AVMA and have PLIT insurance. Notify them of every potential case. Get a team in place before the letters, lawyers, and subpoenas arrive. Remember that your PLIT appointed lawyer works for a company, not you. They are there to protect you but are paid and must remain employed by someone else. I  think that in 10 years I have called them 6 times to alert them of the potential of a suit. I am sure my folder isn't the thickest in their office, but I may be the most proactive client they have. Oddly, I still only pay $69 a year for them to answer my paranoid phone calls.

• There are battles where no one wins. There are fights that cost you more than green backs. Lawyers will be paid, you will lose time and money and the case will close. Let go of being angry. Don't swap one bad emotional crutch for another. 

Get out alive. Preferably not bitter and hating your fellow man. We have a legacy of humility, generosity and compassion to live up to. Leave the ugly stuff to the lawyers. I recommend you find one who is the yin to your yang now. The clock is ticking. Have you had your 36 month case yet?

Related blogs;

Working and Living the the Land of Liability.

We Don't See You. How Vets became biased and lost our clients in the process.

Fear and Guilt. Why these won't help your pet get better, and why our pets are smarter than we are.

Compassion Fatigue.

There has to be Mercy Before Money.

Weasely

Footnote;
It has been many months since I had my last brush with the long arm. I remain a bit bitter and biased and convinced the vets with  friends in influential and politically flirtatious positions avoid being placed in the spotlight, or questioned when complaints are filed. It is a seriously flawed secretive system. As with much of veterinary medicine is archaic and severely lacking jurisprudence legitimacy. Any legit constitutional lawyer would laugh at our Lord of the Flies self governed veterinary judicial circus. I take great comfort in being reprimanded for not offering euthanasia to a 5 month old puppy with treatable injuries who I had treated, was subsequently blackmailed (by both the MD State Board and owner) to return and refused to. Turns out you can kill a cat with an arrow and still keep your license. Laughable,  ridiculous, and inane.

Stand up for what you believe and never let fear of reprisal abandon your compassion.

Dunkin

Find me at the clinic, Jarrettsville Vet, on Facebook, Twitter, YouTube, or providing free vet advice on Pawbly.com. 

"I wash my hands of this cat."

Simon

This is a true story. True as I can make it and still protect the identity of the characters involved and the ironic sad truth that these scenarios happen.

The clinic we built centers around a mission of helping pets. Jarrettsville Veterinary Center provides our community with a safe place that provides exceptional medical care, and this doesn't cease when our clients can't pay, or give up being guardians. Very simply we care and are always more than a business.

Like all of us trying to live adherent to a higher calling we are challenged to follow through with our conviction when the hail storms fall. Life will dump crap on you just to see what you are made of. You aren't unlucky, you are instead being given a chance to shine amidst stormy weather.

Such was the case of our newest addition; Simon.

We had never met Simon before the day he was brought in to our clinic to be euthanized.

His story started out as many other indoor cats does. A cat like so many others who was adopted, vaccinated as a kitten, altered as a 6 month old and kept behind the doors of his family since. He was brought in to us as a middle aged tabby who had lived with his family for almost a decade.

Simon is a rather rotund soft soul who prefers to sleep sunny side up unabashedly flashing the staff unconcerned with the bustle of a busy veterinary practice.

Simon arrived in a cat carrier escorted by two sobbing women on a day when the reception area was packed. Crying clients carrying a pet in a vet clinic is the universal sign for departure over the rainbow bridge.

If we know that we have a patient coming in to be put to sleep we take great care in getting them into a quiet room quickly. Minimizing stress, strangers glances, and having to share your grief with anyone else is eliminated. Saying goodbye is never easy, but we do every single thing we can to make you and your pet feel that there is love even when there is goodbye. We didn't know Simon was a one way trip and the odd scene of a crying family eliciting and seemingly enjoying empathy from the other waiting clients was beyond disturbing. This is a job where uncommon things are common, but this scene was alarming and disconcerting. The technicians quickly found a free exam room and quickly alerted the unsuspecting vet that a euthanasia appointment had arrived.

The news of an unscheduled euthanasia for a seemingly bright, alert, and active pet quickly swept through the clinic. I walked by the exam room to take a peek at the lugubrious couple with the new arrival and the death sentence.

Two women lay on the floor sobbing as a fervent joyful feline sopped up the abundant attention doted upon him. They cried and smothered him with pats, strokes, hugs, and last sentiments of the wonderful cat he had been. It is a juxtaposing scene a veterinarian sees often, a grief stricken guardian sorrowfully pleading a good-bye that is too great to bear for any onlooker. BUT, there was Simon, happy as a lark, full bodied, well groomed, and soaking up the affection greedily.

Clearly, something was amiss with this? My curiosity and sixth sense of experience and regrets kicked in.

"What's the deal with Simon?" I asked the vet as she departed the exam room.

"He's been peeing on their laundry for a year." She replied with a sigh and disgust. "They can't afford to treat him."

"Has he ever had a urinalysis? Have they ever worked him up for a possible medical cause?" I asked. This is the usual response of a vet in these cases.

"No. They have never brought him anywhere. Never done anything about it." I could see the pain in my friends eyes. These are the cases that add nails to your coffin.

"What if we used some of the donation funds to help with the diagnostics?" I offered. I knew that keeping a pet with a family that loves them is the safest place for a pet. I would rather help a client through a financial tough spot and keep a pet in its home then try to find a new home for an adult cat. "What if we offered to pay the entire bill to get Simon the diagnostics he needed?"

"I tried that already. They just want to 'wash their hands of him.' Their words, not mine." Her face fell to the floor and the vice of a helplessness assassin replaced her normal vibrant optimism.

"What do you think?" I asked of her. I know that she was going to have to be the person who bore this burden. Working in a veterinary clinic can be a terrible place to have a conscious.

"Simon appears to be a healthy, sweet affectionate cat. I don't want to do it." She said meekly back.

"Then don't. Offer to have the cat signed over to us, and tell them to never come back. If they refuse explain to them that you don't feel right about it and walk away."

Elated and gleeful she burst out an "OK!" Her smile returned to her face.

I often feel like a parent to the staff at the clinic. That smile on her face is worth every disciplinary action of every board member reminding me that my job is to treat pets like property and comply with owner requests. The way we are asked and expected to treat the pets the law deems as property has ripple effects and consequences on us. I don't ever forget this. I stand by my patients, my staff, and the ability to help both. The law, well, that is a belief that changes with time, it is not a conscious with burdens to carry to the grave.

Simon's family left through the waiting rooms front doors wadded tissues in hand to a crowd of clients hugging and sobbing condolences of understanding and compassion. They further had the audacity to embrace every bamboozled empathetic person on the slow dramatic march out the door.

Simon's bloodwork and urinalysis confirmed he had a urinary tract infection. Like so many Pawbly questions I answer, people assume a cat is being spiteful and therefore not using the litter box, when in fact they have a real medically based problem. Poor Simon spent over a year trying to notify his family that there was a problem and their answer to him, "wash my hands of you."

I might live a long healthy robust life, but I remain steadfast in my devotion to pets and children. People, well, I just don't understand them? If I try to I feel disgusted. If I give up on them I loose my faith in humanity. Which is worse? So, I do what so many of us do. I do as much as I can for all that I can. Jarrettsville Vet remains committed to help pets in need. Thanks to the community and our friends we are able to continue to do this.

"You're welcome Simon. We love you too."

Simon is an outgoing, affectionate, charming boy. He loves everyone and everything and would make an excellent companion. He, now minus his urinary tract infection, is up for adoption at our clinic, Jarrettsville Veterinary Center, inn Jarrettsville, Maryland. We also have other pets in need of homes and we would greatly appreciate your help in spreading the word about them.

If you have pet experience that you want to share, or a pet question in need answering, you can find a group of caring knowledgeable individuals at Pawbly.com. Pawbly is free for everyone to use.

You can also find me on Twitter @FreePetAdvice.

Related blogs;

Peeing Outside the Box. The 20 Minute Cure.

Feline Marking. What is it and how to stop it.

When your Client Gives Up On Their Pet. Where do you stand? The cat and the line in the sand.


Related Pawbly questions;

How do I stop my cat from peeing on my lounge?

My cat Sally has been experiencing a lot of urination problems. What is cystitis?

Male tomcat not using the litter box anymore. Why?

I just adopted a cat from the shelter and he's scared of the litter box. What can I do?

Simon has been with us at the clinic for about 6 weeks. there has not been one single episode of him urinating outside of his litter box. He is a calm, happy, sweet boy who wants nothing more than a simple life shared with someone who loves him.

Can you imagine having your guardians "wash their hands of you" because you have an infection? Happens every single day in countless veterinary clinics around the globe. It breaks my heart.

Simon reminds me every single day that it takes so little to care but does so much when you do.

Working and Living in the Land of Liability.

Jekyll reminds me to stay clear of his couch.

I write a lot about the state of my profession. Where we are, where we are going, and how much of a cluster it can be along the way. As bleak it may seem at times to look ahead, and, as up-and-down it can be in the midst of it, there is a reason we got here, and a path we are forging in our quest for a future.

Let me give you a back story to help you understand this. Recognizing and understanding how we got where we are, and how much we need to put up a few warning signs so that we don't all kill ourselves as our only, or best, way out is vital to the longevity of this profession.

I was just like so many pre-vet students.. I was LIVING to attend vet school.. it wasn't a want for me, it was an unyielding, unwavering, blind ambition. There was no talking me out of that destiny.
Unfortunately, as many of learn later, there is the catch 22 to blind obsessive lust.. those break-ups are shattering.

Trying to keep yourself in love with your career is a silly juvenile wish. Even a decade later I still love being a vet. I love it for all of the reasons I knew I had to do this. I love medicine, the pets I meet and the stories that unfold over days, weeks, and even years. If you can keep yourself getting up everyday, putting on that white coat, and clocking into the list of daily appointments you become a skilled, versed doctor. But there is a cost to each decision you make.. I have also learned that I have to be careful what I surrender on my path toward retirement.

I read about a lot of my peers venting. (Here is the latest blog regurgitating an average work day for us, "The Harsh Reality Of Vet Med, by OCRTriVet). Long hard days with barely enough time to take a lunch break, and rarely enough time to go to the bathroom. We routinely arrive at 8 am and leave after 8 pm. This is the norm. In between those 12 fleeting hours are the highs and lows of serving the public who can and will treat their pet like a disposal piece of furniture, or, be so emotionally embroiled they barbecue you on the emotional roller coaster that a family pet represents.

Wake up time.

I received a comment on my blog about Charlie and his rather large lipoma surgery. The crux  of his story was not his lipoma, but that his family was seeking to euthanize him without trying to remove the offending mass that was impacting his ability to function on the most basic levels. They felt they had no other options. With a few tense discussions they allowed me to try to remove his mass, which thankfully, was very successful.

Here is the comment I received on Charlie's blog;

Unfortunately we live in the days where people sue everyone, or take you to court over the slightest things. 
While I commend you for doing this surgery, did the owners have to sign any other significant paperwork? The reason I'm asking is that a case was put to the ava board about a cat that had surgery and due to financial restraints a different approach was done, and although the outcome was the same, this was frowned upon by the board. 
The said people were told about possible outcomes and they agreed to the surgery. 
I just find after reading about that case, and about this surgery, we know that yes surgery is an option and a great risk, but also scary for the vet in case something does go wrong, then your left with a dog who can't use the leg, or where amputation wax needed in the end!

Best side selfie

Here was my response;

Hello,

Thanks for reading and for your input. With respect to liability, the board, and proper paperwork to cover my butt.. I have decided long ago to follow my heart, my calling, and to always help a pet in need. Even if it is leaves me being vulnerable to nasty litigious people, and the board. I have already been reprimanded by the board for refusing to euthanize a 5 month old puppy with multiple pelvic fractures who was signed over to me, then sent to have her fractures repaired by a boarded surgeon, then found a home for.. after which the owner requested I return her. Which of course I did not.. It was, in my opinion, a case of professional blackmail. The board was upset I didn't regard the puppy as property, to which I admitted, and euthanize, or return her. So, I'm ok, with helping pets even if it means I deal with this.

If you aren't making waves perhaps you don't stand for anything worthy? Or, perhaps you are content with status quo? 

Charlie was at my clinic to see me to be euthanized. How many vets would have chosen that because it was easier and protected their liability? We are dealing with a profession plagued by suicide, compassion fatigue, and despair. I blame the board, our litigious society, and our inability to listen to our gut and stay true to the reason we became a vet in the first place.

I hope that more people stand up for their patients, their conscious, and stick their neck out to help. 

Again, I appreciate your thoughts.

Sincerely.
Krista

Typical family portrait

So, I wonder, where do you think we should stand? And, if we are working so hard to stay afloat, why are we sacrificing ourselves along the way?


Related blogs;

Compassion Fatigue

Taking A Stand and Facing Consequences

The Holes In The Safety Net

Burnt Out From Being Burned

The Pets Are Never the Problem

Advice to New Vets, My Top 10.

If you have any thoughts on this blog I would like to hear them. If you are a pet parent with a pet question or thought you can join me on the free pet community Pawbly.com. I can be reached for questions here or via the vet clinic, Jarrettsville Vet, or via Twitter @FreePetAdvice.