Here’s an ethical dilemma on what might otherwise be a boring Tuesday:
A new client comes in with a dog whose leg has been broken since last February. Though the leg sports an impressive external fixator device (one of those scary but sometimes necessary tools used to piece a broken leg together), it’s clear this semi-young dog’s leg ain’t fixed (he isn’t using the leg at all).
You spend twenty minutes downloading the complex story from the owner. Here are the basics:
She finds the dog five years ago on the street with a broken leg. $2,500 in surgery later the nerve that was accidentally sliced in the process leaves him with a club foot.
The neuter surgery for his cryptorchidism? They couldn’t find the abdominal testicle so they told her it must not be there. Yet we can infer the dog is still intact by the way he responds to females in heat in his neighborhood. She still got charged an extra $250 for the “complicated” neuter.
Dog’s leg is broken in a sofa-recliner accident last February (same leg as the first time but a totally different bone). $4,000 later she’s told it’s healing fine. Months go by. X-ray after X-ray, she’s told the leg is “trying to heal.” Last week (9 months later) they finally told her another surgery was needed to “finalize the healing process.” Another $2,500.
Alternatively, she could elect an amputation for $2,000.
The last straw, I guess. That’s when she takes her manicurist’s advice and comes to see me.
Not that I’m much of an orthopedist, but I can tell this leg will need at least 2 surgeries and a LOT of physical therapy to save it—if she’s lucky. While the most recent bone was “trying to heal” the old fracture site (which was incompletely handled, to boot) has formed a crazy bond with the nearby hip joint. The hip doesn’t move at all. And the club foot? It’s not helping any.
So I ask an innocent question (sort of): Who was the surgeon?
Turns out she saw the surgeon on the two orthopedic surgeries exactly once before each of the procedures. She was impressed with his credentials, she says. She tells me his name.
He’s no board-certified surgeon. He’s got no stellar credentials. His claim to fame is offering his surgical skills, such as they are, to veterinarians who prefer not to refer their patients to board-certified surgeons so they can turn a buck on the ancillary surgical services (fluids, antibiotics, hospitalization, pain medication, etc.).
He’s a ghost. He comes in, charms the clients, performs the surgery in a general practice facility and leaves. Needless to say, his complication rate is high. Some owners complain. But most don’t. No one ever takes him to task—least of all the vets who use his services, complicit as some of them are (though by no means all) in misrepresenting his credentials.
His rates? They’re higher than for any of the boarded veterinary surgeons I know. His overhead? Not much—one tech and some specialized equipment. He’s raking it in—no doubt about it (but I guess that's beside the point, isn't it?).
So here’s the dilemma: I hear of one case like this dog’s (out of this practitioner) every couple of months. True, I keep my ear to the ground, but I’ve got to guess my knowledge is just the tip of the iceberg.
Do I…
a) Call the Board of Veterinary medicine and lodge a complaint.
b) Urge the owner to call the Board and lodge a complaint.
c) Do my best to let the owner know how egregiously mismanaged her dog’s case was and explain the surgeon’s inadequate credentials so she can do what she sees fit.
d) Offer to amputate the leg for $700 and call it a day.
Unfortunately, option “a” is unavailable to me. I’m not the aggrieved party and cannot testify to what this owner was told and I have no access to the records which might elucidate the true facts of the case.
Option “b”? It’s a possibility. But if things go sour in any way and I’m found to be behind the complainant’s complaining, I could theoretically be sued for defamation.
Option “c”: Sure, I run the same risk as in “b” but as long as I’m not actively encouraging the owner my chances are higher of coming out of this unscathed. Does every vet in town have the potential to know I was involved? Perhaps. Will I be pilloried for my position, given that a large number of hospitals use this man’s services? Maybe. Is anything the Board might do be likely to mend this “surgeon’s” ways or protect more pets? Not likely.
That’s why “d” was my answer for this case.
Though some of you might suspect that vets don't complain against vets and that it's our inherently unethical self-preservation that's the root cause here, I'd submit that you consider the complex nature of the machine. It seems, the more I think on it, that our industry's just not set up for appropriate peer review or safe whistleblowing.
Unless drugs, alcohol or blatantly illegal activity is involved, a vet's anonymity is not preserved when he/she requests an investigation into another veterinarian's potentially harmful activities. There is no system for raising questions, even when an entire community is involved. Other professions offer greater protections but mine isn't one of them.
Your thoughts?
Add Comment90 Comments
Well, thank you for that post. It's not an easy issue for a vet to write about. It is however, proof of the very sad state of affairs in regulation of your industry. And even further proves the point that people like me -- on the outside -- need to be screaming our heads off trying to inform owners of their right to file complaints; trying to get them to question the quality of care they are given, etc. And though you are sadly correct that the vet board is not likely to do anything significant enough to serve as a deterrant, if they manage to get a ruling in their favor, they at least have some public record to use -- albeit meager -- to warn other potential clients -- safely, without opening themselves to defamation. I'd also like to believe that speaking out online -- bad reviews -- helps warn people. Yup, vets sue for defamation. But last time I checked, those lawsuits aren't going very well for the vets who file them. I suspect they realize they have little chance of winning. What they are counting on instead, is that the mere threat of a lawsuit will scare and intimidate people into silence. It works with so many people. Look -- the threat didn't even have to be explicitly made, and it worked with you. I believe that as long as people like you inside the industry -- who would like to speak, who could speak, but who instead remain silent because of the chunk of hide your colleagues will take out of you if you do speak -- don't speak up, your industry will not raise quality standards or deal with the problem of pervasive malpractice. There are a few of us committed to going public about the very circumstances you speak about. We are hoping if we put enough pressure from the outside, eventually, those of you on the inside will finally be pressured into changing the situation you describe. All advice on that score appreciated. Silence isn't working. Oh, and there are a few states that do look into anonymous complaints, although by their nature, they stand much less chance of success.
Stefani November 11th, 2008 10:05:42 AM
Teh evil in this world exists because good people (vets? doctors? clients?) let it.
Jerb November 11th, 2008 10:12:01 AM
I think you have an ethical obligation to choose at the very least "C". It is both yours and other vets unwillingness to step outside the box that allows this "vet" to continue his abuse of the system, the clients and the pets. And like it or not, but botched vet work is abuse. This animal was suffering by having the complications that were directly related to shoddy surgery. This is one of those cases where your being of the opinioned type of person (or otherwise you wouldn't blog) really can do more good than just airing out. Have the nerve to do the right thing here. Save other animals from the hands of this moron.
LorriM November 11th, 2008 10:15:45 AM
I can take it. Keep it coming.
Dr. Patty Khuly November 11th, 2008 10:17:23 AM
I would do d and request complete records with Doctors' notes, you need this information to proceed medically. From there you can go to c, especially if you do not get cooperation receiving the records, which I predict will happen.
Hobson November 11th, 2008 10:25:58 AM
In addition to the culpability of the "surgeon" there is culpability on the part of her general practice vet and all the other vets who promote him as they are certainly aware of his shoddy treatment and exorbitant fees. I agree with others who have posted already that there is an ethical/moral duty to do something more for the sake of the animals subjected to this torture. Would it not be possible to do basically c, couching the discussion as "what I would have done if I had treated this dog from the beginning"? And including a factual analysis of the surgeon's lack of certificaton/qualifications - why you would not have referred surgery to this person? One step further, of course, would be to suggest that the dog would still have a functional leg today if his treatment had been managed differently. The other thing that could potentially help, IF all those other hospitals/vets are ethical, would be to present this case to them as an example of the abuse that their support for his "practice" is abetting. The ones who don't care won't change. But the ones who do care will. And the potential for liability/complaints against them for having used his services should also be obvious to them from this case. My dog's diabetes case study was written with that goal - the vets who don't really care about good diabetes management wouldn't change but the ones who did might at least think about it differently next time they saw a diabetic dog. My philosophy is to put it out there. At worst, nothing will change. But maybe something will change if you put in front of people. I'm so sorry for this dog and sorry that you have been put in such a difficult spot. I hope that guy can be drummed out of business, perhaps by the vets who make it possible for him to continue to practice.
Natalie November 11th, 2008 10:54:49 AM
Dr Khuly are you comfortable with the choice you have made?
Elizabeth November 11th, 2008 11:31:08 AM
I know how you feel from a vet point of view, but how would you feel from an owner point of view. Most of us don't know what went wrong, until we do the resarch, study the records and the availalbe info, and maybe, just maybe, are told by another professional what actually happend. I understand why you are keeping quiet. It is easy and safe. But it certainly isn't doing your client - or any client who sees this surgeon any favors. I'm thinking of trying to find a new vet as my current vet is more than an hour drive away from me. It scares me. I know too much about many of my local vets, and now I'm reluctant to trust any of them. Knowing you'll never get a straight answer from another vet for "fear of a lawsuit" is just sad. for many, pets are just property, and keeping your mouth shut is a reasonable course of action. But for those of us who love our pets, and would go above and beyond for them, putting our fur-kids in the hands of these types of doctors due to lack of information - well it makes my soul shiver.
Connie November 11th, 2008 11:31:56 AM
and I forgot to add - Kudos to you for doing the surgery at a reduced price.
Connie November 11th, 2008 11:33:09 AM
Dr. K - liking the Dolittler 2.0 so far. :O)
But agreeing wholeheartedly with the above posts. Even as a layperson working at a pet supply store, I know how much trouble I can get into for telling someone that the services they received from their vet were shoddy at best, and unethical/dangerous at worst. And yet, a few times a week, I find myself providing someone with information they didn't get (and SHOULD have gotten) from their vet in order to file a complaint, or at the very least go back to said clinic and speak with the owner about getting a complete refund of the fees paid thus far.
A perfect example happened just yesterday. Not as dramatic as yours, of course, but a good "middle ground" example of what I deal with weekly.
First, you should know that this particular pet owner is on disability. They don't have a lot of money. However, they have been getting regular puppy check ups for their 8 month old cockapoo like responsible pet owners, and paying towards this practice's spay/neuter payment plan.
The puppy has been dealing with a "rash" (as it was first described to me) pretty much since they got her. The vet has treated twice with antibiotics, and has not done a skin scraping. Odd? I thought so...
So they continue to explain that at this point puppy is a total mess, the rash covering the belly, underarms and now face of this poor creature, and the vet's response was an $1100 estimate to do a biopsy. Still no scraping offered. Now puppy has a secondary infection, to the point where there's an actual odour. The vet's final recommendation to them was basically if they can't afford the diagnostic then the probably can't afford the treatment, they should find puppy a new home. The vet's office is closed down for renovations, and they have no way of getting their records to another vet. They need help, badly, before puppy's infection becomes more than just a topical issue (really, we're talking hours, if not already).
I ask if their vet has suggested that puppy possibly has mange. I go on to explain that immune-mediated demodectic mange displays exactly like what they are describing, and I'm quite frankly stunned that the vet didn't do a skin scraping immediately. They do a quick search online, come back and report that the photos they view look exactly like what puppy is suffering from. I send them to a local clinic I know is cheap and will do tests on demand, and they diagnose mange pretty much immediately. Antibiotics, some Ivermectin, and we need to have a long discussion about what to do about puppy's immune system for the future (diet, immune boosters, etc) but we now have a diagnosis and the beginnings of a treatment for under $150.
Poor puppy has been suffering needlessly for months, and these owners were treated like dirt to boot. I'm furioius, they're just relieved that puppy is ok, and I'm urging them to report this jerk to the board asap, as well as insist on a complete refund of their puppy package pre-payments (my vet will do it for half that price anyways.)
Will I get a call from said vet? Probably... I've been called, threatened, etc, etc. Sometimes they even come into the store, posing as customers to see if I'll say anything they don't agree with so they can harass me some more. I don't care, it doesn't matter. What matters is puppy, and all the puppies that come after her. I won't have it on my head that I could have done something to light a fire under this vet's arse and didn't. I'm not a "turn the other cheek" kinda gal. Sorry, Dr. K.
Honestly, even a "if you tell anyone we had this conversation I'll deny it" line or hinting to her to ask you the right questions... you can't be faulted for telling a client your professional opinion, how you would have handled things, etc. It's situations like this that go unreported that lead up to disasters that end in deaths. This one already ended in a maiming... how far does it have to go?
Kim November 11th, 2008 11:48:36 AM
Nobody in this world is above reproach and if you do wrong, you should pay the price and suffer the consequences for your wrongdoing. If the decent vets are not willing to really fight for the integrity of their profession, then they are no better than the vets who are negligent. Not doing the right thing can be just as bad as doing the wrong thing. I am challenging you to do the right thing.
Greg November 11th, 2008 11:49:29 AM
Natalie - I would love to see your study on diabetes management in dogs. You can email me at kim.helstein @ gmail.com
Kim November 11th, 2008 11:57:05 AM
I understand for the sake of the immediate care going with option D. However, it seems to me at the very least option C needs to happen. How many other dogs have suffered because of this man? If there some type of blog or information network on this man by others that have been wronged by him? Is there someone you could put this particular owner in touch with to give her legal advice? I can't help but fear for all the other cats and dogs that will become victims of this man's greed, the complacency of the GP Vets, and the denial of his victims.
CreatureofHabit November 11th, 2008 12:00:09 PM
I echo the comments posted. I am guessing the client voiced serious concern of negligence and may have solicited your opinion on how to handle this. At the very least suggesting to obtain all the records for independent review would be helpful. So I believe (c) would be appropriate. Also, everyone should read the Federal "whistleblowers" act, that provides protection when an individual seeks to protect the public from harm, regardless of whether on a local, state, or national level. Harm is a broad description. We immediately view harm as the suffering this animal has gone through, but public harm may be defined "monetarily" and statutes range from state to state as what constitutes larceny, etc. If, I'm adding up the money damages correctly, are we talking app. $10,000, including your final repair (amputation)? Finally, as others have pointed out, libel & defamation's defense is "TRUTH". Having a dog's leg in a cast for 9 months,unusable, speaks for itself. As much as vets "band together" to protect each other, it could just as easily go the other way and band together and "out" them. Who has the ultimate moral & ehtical ground for defense?
Barbara "Pocket's Story from NH" November 11th, 2008 12:08:13 PM
It must be a hard choice to make when you're a vet and can face issues from speaking out. But as a simple pet owner, I feel some level of outrage at the idea that such obvious mistreatment can be allowed to continue with nothing more than a momentary wringing of the hands on a blog. And vets wonder why so many pet owners don't trust their words?
EMoon November 11th, 2008 12:15:43 PM
ok first Dr K this guy IS NOT a FELLOW vet- he's a quack. He is "doing harm". I couldn't stand by and let this butcher NOT be reported. Surely you have a connection who can make the board AWARE of this guy... it's great that you want to fix the pup, but sometimes you have to take a stand and do what's right...I don't say this lightly. I've done it, and left a job because of it. But I know I did what I could do, and sometimes that's all you CAN do. Please call someone about this monster. He ranks up there with the vet in Tennessee who was doing the heart stick euthanasia.
agadoresmama November 11th, 2008 12:20:15 PM
The Wall of Silence is pernicious in human medicine, and it's pernicious in veterinary medicine. I had a dog who suffered for months with what the quack we were seeing insisted were allergies. As it progressed further and further and looked more and more like my poor Brandy was being eaten alive, we finally found another vet, who said, "mange," and things immediately started getting better. But would the new vet even go so far as to say that any competent vet should have recognized mange? No, of course not. Got to protect one's "fellow vets" even while cleaning up their messes. But how often have you harshly condemned pet owners for lack of knowledge, lack of diligence, lack of understanding of what seems obvious to you? You need to at least let these clients know that this fraud isn't a board-certified surgeon, that he is not competent, and that even though you can't go on the record against him, they do have an avenue to complain.
Lis November 11th, 2008 12:37:13 PM
To expand on agadoresmama's post, one would think (as myself specifically) that in a state of nearly 600 practicing vets, that it would be fairly easy to "out" a clinic known within my state, and other states, of breaking the existing "humane euthanasia" law, that drops the bar so low to "acceptable" treatment of pets and the ultimate level of "shame" to all the good people within the profession. It is unacceptable by ANY reasonable standard.
Barbara "Pocket's Story from NH" November 11th, 2008 12:44:37 PM
Actually, another thought on your post: It goes to show, that the responsible vets DO KNOW WHO the "bad" vets are. When this lady told you who, you weren't surprised -- you already knew the deal with this guy. So, you know how he operates but still feel the price of speaking out is too much? If that's true, what hope do we pet owners have? Lis said "even though you can't go on the record against him" . . . I guess I'd like to say that you CAN. It IS done, by some vets. They give us second opinions for our complaints. They may not be written -- it may be simply having the cahones to show up at the vet board conference and tell the truth. I had one vet willing to do that in my case over Toonces. She told the truth, contradicting statements being made by the vet. Last I checked, she still had her job and has an awesome reputation as a neurologist. Even techs have told me, when I recounted the story, "Yup, that sounds like her. She doesn't put up with stuff" or words to that effect. And they respect her for it. It is possible to speak out. The more who do, the easier it will become, until its no longer something to fear, but rather something accepted and encouraged, if not accepted.
Stefani November 11th, 2008 12:50:46 PM
I meant, "If not expected."
Stefani November 11th, 2008 12:52:02 PM
It’s a good sign that you even have a moral dilemma about this. That probably puts you in the minority of vets, sad to say. First, I’m not a lawyer, but here’s what I’ve learned about libel/defamation by being sued by, yes, the same vet who stuck my 20-year-old dying cat in a box and gassed her under horrific conditions without my knowledge or consent, and then walked scot-free after a board investigation. In the course of 2 ½ years of fighting defamation litigation from this vet from HELL, I learned that my statements to the vet board were PROTECTED as long as they stayed within those confines. For example, the statements I wrote in my 54-page complaint to the state board were completely protected; if I had handed out copies of that complaint to anyone else, they were not (they were all true, however, and truth, as Barbara pointed out, is the absolute defense to defamation). So if you were to file a complaint ONLY with the board about this vet, as long as you didn’t show it to anyone else, you would be fine. This would be done in conjunction with a simultaneous complaint filed by the owner. I think your best avenue, would be to offer yourself as an expert witness to this client SHOULD she decide to pursue it, since an expert is the toughest thing to get in a board/legal setting. You treated the dog. You are the perfect second opinion/expert witness. I would be careful about taking this to other vets. Publication of any statements (including orally) can be grounds for defamation, and you’ll get into a lot of he said/she said with that stuff. We have a whistleblower here in Texas who did file complaints against a vet in Houston running some kind of vaccination scam. The board never did a thing, of course, but I don’t think the vet was sued. He has had some problems, though, getting vets to work for him. He’s brave, but he’s paid the price. Point is, you can’t sit by and do nothing. You just can’t. You can do what protects you the most, but you also have to provide some level of protection to the animals from this guy. If even ONE person had gone after the freak who did this to Suki, he might not have been around to do it. As it is, there were/are people who knew about this guy and did nothing. And he’s still happily practicing with a clean record and calling me a liar. Believe me, the dog you saw probably represents only a fraction of what that vet has done. This sounds like a perfect opportunity to at least notify the board (safely) that should any complaints come in about this guy, you will be happy to serve as a witness.
Julie November 11th, 2008 12:56:34 PM
Stefani's right - the neurologist who spoke up does have an awesome reputation. You may find yourself entering a new level and phase as a vet who cares. Will there be a price? Possibly. But it will be worth it because you will gain a reputation as someone who just might put the needs of animals before the needs of vets, which would be a giant step forward for animalkind. There is a sea change going on here, believe me. Might as well be a leader and not a follower. What's that saying? "Be bold, and the universe conspires to help."
Julie "Suki's Story" from Texas November 11th, 2008 01:01:37 PM
The case study is available online at www.k9diabetes.com/k9diabetes.pdf. I just finished updating it to cover our dog's last three years.
Natalie November 11th, 2008 01:09:59 PM
Not sure what's allowed on Dolittler 2.0... [URL]www.k9diabetes.com/k9diabetes.pdf[/URL].
Natalie November 11th, 2008 01:10:53 PM
I guess I'm one of the lucky ones ... I found a veterinary practice that I trust to care for my cats and that I'm completely satisfied with. Of course, it was not the first practice that I tried. I left the first after receiving inadequate information and a non-diagnosis, which was immediately addressed by my current vet. In all the years(almost 9)that I've used this practice, there has only been one vet that I was uncomfortable/unhappy with ... so unhappy that I would not make appointment for the days that she was on duty; while I won't deny that she did appear to care about the animals, I truly felt that she cared more for the money that she could charge me. My opinion must have been shared by others because it wasn't long before she was no longer part of the practice. All of the above is just to establish that it is important to me that I have faith in the person that I entrust the care of my pets to, which includes any specialists that might be necessary; of course, any specialist would be someone my vet refers me to. I have to trust that my vet would be aware of the specialist's qualifications and general level of skill. So, my question is ... if you know that this doctor is slipshod and causes more harm than good, how can you not report him or encourage your client to report him? How can it be defammation if you have a file that clearly shows the damage that has been done?
BERNADETTE November 11th, 2008 01:30:52 PM
if reporting this 'surgeon' means possible backlash on you, to the point of losing professional credibility, or being brought before the board yourself for debasement of character... i think you made the right choice.
the world needs more veterinarians like you. i trust you made the best possible choice--only you know all of the details behind this unfortunate circumstance.
Charity November 11th, 2008 01:36:19 PM
Hahaha! Does anyone else find it peculiar that such a "me first" statement is made by someone who goes by the name of "Charity" ?
Greg November 11th, 2008 01:42:43 PM
I do find this subject upsetting. It's horrifying that good vets like you are put between a rock and a hard place. I'm going to look into how this works in my country (Do I have high hopes it'll be better?No, unfortunately). My father didn't get his contract renewed after he whistleblew on the corruption in the not-for-profit organisation he worked for-the only similarly-paid job he could find was 3 hours drive away so now he lives apart from my mum and kid sisters during the week-a hard price to pay for doing the right thing... the system really needs to change (and not just in veterinary medicine).
Sian November 11th, 2008 01:52:04 PM
There needs to be a push to change the rules in the Veterinary profession. I am a lawyer, and if I were in your shoes, I would have had no choice -- I would have had to report the malpractice, or be in violation of the ethical rules myself. Such a report is protected from defamation claims (probably an exception for actual malice, which I have never, ever heard of being done in my 20 years of practice). In a defamation case, Truth is a complete defense, not that anyone wants to deal with the expense or hassle of a lawsuit. Honestly, in a case as egregious as you described, I would seriously have considered urging the owners to (1) obtain their records and (b) file a complaint. But I understand your dilemma. Think about working from within the system to change it so the good vets don't have to be in your quandary.
Susan November 11th, 2008 02:12:42 PM
Ha! I had the same thought, Greg. First, in Texas we have board statutes in place that make sure that vets are not penalized for testifying against another vet. Second and more importantly, this is about doing the right thing for the ANIMALS - NOT the vet. But I'll tell ya one thing - that vet is LOVING that he has the other vets too scared to speak up. Fear of backlash is what these creeps count on, and they are pretty sure that fear keeps everyone in check. (Well, not everyone - check out www.vetabusenetwork.com/savetoc.html
Julie "Suki's Story" from Texas November 11th, 2008 02:12:56 PM
A belief that I have had for *many* years, is that to become a veterinarian takes an awful lot of courage all by itself. Particularly a GP. From my POV, you have to see the goriest of blood & guts, the saddest of sights, smell the stinkiest nauseating smells, hear the bloodcurdling screams or sounds of the dying. To top it off, then deal with the vast variety of clients from the nicest to the insulting,hopeless ignorant, the uncontrollable grief-stricken, and I'm sure every once in awhile, some of the people are downright frightening to say the least. I'm in awe, that this courage does not carry over into speaking up for what is "morally and ethically right", from both within your profession as well as the public, which consists of two groups :animals and humans. I think fear and intimidation has gotten too much of a stronghold, it is perceived to be greater than it really is. My comments on this blog and other sites all over the country are "not protected" by any sort of disclaimer...my "truths" are bad enough and don't require embellishment for my message. The profession as a whole must harbor huge self-doubts that the public cannot distinguish between an honest "booboo" and blatant, egregious negligence & deception.I, and many others, believe that for the benefit of your professional group , time for change is here.
Barbara "Pocket's Story from NH" November 11th, 2008 02:20:31 PM
Dr. Khuly, for us, people who have suffered greatly from the incompetence of certain vets and their immoral colleagues, it is refreshing to see that you even "ponder" the issue. The others do not have any qualms being dishonest in covering up for their buddies. I even sent a letter to the veterinary association judicial committee about this (no answer, of course). We and our pets are the ones truly short-changed, to say the least. When my beloved cat, Smokey, died as a result of veterinary negligence, I asked around to see whether anyone knew of a vet who would offer an expert testimony. The consensus was that in the are I will not. It was considered totally "understandable" that no one will testify against a colleague. Why is it considered testifying "against?" They would be testifying FOR the truth. They are asked to state their objective professional opinion based on objective evidence. It shouldn't matter who the vet in question is. What should matter is stating the truth. Vets' professional integrity should compel them to do so. If it's such a touchy issue, then an anonymous testimony procedure should be in place, in which the testifier does not know the identity of the vet in question and vice versa, even though this shouldn't even be necessary: if I testify with all my professional integrity to a god honest truth, I shouldn't be penalized or ostracized for my act; it's my obligation to do so, morally and professionally. Some cases where vets refuse to state their professional opinions are OUTRAGEOUS: I have a friend whose cat died late at night at an ER due to an act of malpractice committed by his regular vet. My friend asked the ER vet to testify to the cause of death and he refused, saying he didn't "want to get involved." Instead he advised my friend to take her dead cat, PUT HIM IN THE FREEZER, and find someone else the next morning willing to get involved. I think this ER vet's license should be yanked just for that!
Natalie Kramer November 11th, 2008 03:09:45 PM
I guess that I feel fortunate to have the tendency to listen to my "gut" instinct and challenge any advise I am not so sure about. Which makes me UNpopular with vets/medical professionals. Oh well, your delimna is exactly why I do it. I worked in regulation for another health field and know that just because someone has credentials doesn't mean they are too be completely trusted in their knowledge or decisions. SO, with that said. I feel that at the very least you owe to inform the patient of your knowledge of the situation. It is up to them to pursue any action. To back it up you should have the medical records of the previous service. IT is outlandish service such as this that infuriates me...and if the client had NOT gone through with some treatment there are incidences where they can be slapped with negligence or animal cruelty!!!!! So Unfair!!! I am so upset.
Thereasa November 11th, 2008 04:10:14 PM
I guess that I feel fortunate to have the tendency to listen to my "gut" instinct and challenge any advise I am not so sure about. Which makes me UNpopular with vets/medical professionals. Oh well, your delimna is exactly why I do it. I worked in regulation for another health field and know that just because someone has credentials doesn't mean they are too be completely trusted in their knowledge or decisions. SO, with that said. I feel that at the very least you owe to inform the patient of your knowledge of the situation. It is up to them to pursue any action. To back it up you should have the medical records of the previous service. IT is outlandish service such as this that infuriates me...and if the client had NOT gone through with some treatment there are incidences where they can be slapped with negligence or animal cruelty!!!!! So Unfair!!! I am so upset.
Thereasa November 11th, 2008 04:10:38 PM
Elizabeth: In a word...NO. But then, I don't yet feel I've actually chosen. So far I've chosen "d", but a colleague, reading this, had a few suggestions for me. I'll keep you posted.
Susan: I'm on the board of our local VMA. I do my best but few see eye to eye with me on this or, indeed, with many welfare type issues. But they're largely older generation vets, of course.
Greg: Got your point. Thin ice, though. Keep it less personal, please. :)
Natalie: Our websites will be accepted soon. Sorry for the temporary delay.
EMoon: Ouch! But you're not wrong.
Dr. Patty Khuly November 11th, 2008 04:27:34 PM
Elizabeth: In a word...NO. But then, I don't yet feel I've actually chosen. So far I've chosen "d", but a colleague, after reading this, had a few suggestions for me. I'll keep you posted.
Susan: I'm on the board of our local VMA. I do my best but few see eye to eye with me on this or, indeed, with many welfare type issues. But they're largely older generation vets, of course.
Greg: Got your point. Thin ice, though. Keep it less personal, please. :)
Natalie: Our websites will be accepted soon. Sorry for the temporary delay.
EMoon: Ouch! But you're not wrong.
Dr. Patty Khuly November 11th, 2008 04:28:56 PM
Elizabeth: In a word...NO. But then, I don't yet feel I've actually chosen. So far I've chosen "d", but a colleague, reading this, had a few suggestions for me. I'll keep you posted.
Susan: I'm on the board of our local VMA. I do my best but few see eye to eye with me on this or, indeed, with many welfare type issues. But they're largely older generation vets, of course.
Greg: Got your point. Thin ice, though. Keep it less personal, please. :)
Natalie: Our websites will be accepted soon. Sorry for the temporary delay.
EMoon: Ouch! But you're not wrong.
Dr. Patty Khuly November 11th, 2008 04:29:44 PM
What if it were a dog of a friend of yours? What if it happened to YOUR dog?
Marie November 11th, 2008 04:39:09 PM
oops. Glitch. Lots of duplicate posts!
Stefani November 11th, 2008 05:13:25 PM
I called Florida Vet board today to ask if they a) investigate anonymous complaints and b) accept complaints from third parties (not aggrieved owners/clients). Totally forgot it was veteran's day, they were closed. If I remember I'll call back tomorrow.
Stefani November 11th, 2008 05:18:53 PM
Dr. Khuly,
I think you know what needs to be done here. And I doubt you really need all of us to tell you. Moral dilemmias are what seperate the good from the evil, the strong from the weak. You don't strike me as either evil or weak. But more as a good vet that walks the thin line. Sometimes and this is without doubt one of them, time to jump the fence. The animals and their well being must come first.
Good that you are troubled by this. All people vets, doctors, lawyers and parents etc..need to be accountable for their actions.
LorriM November 11th, 2008 05:50:52 PM
I've been using a board-certified specialist for about a year now. Unfortunately they are the only one for the specialty in this part of the state. Both my vet and I are not crazy about this person as they do not seem to offer much information on how to handle my pet's condition, even though they have performed the surgery and multiple consultations. There have been complications in part due to the lack of communication. In fact I thought everything was fine (as I was told) and my regular vet was the one that found out it was not. So, even board-certified does not help sometimes. I appreciate my vet's honesty in letting me know they are as frustrated as I am with the specialist. At least I know it's not just me and my regular vet will be monitoring things much more closely because of this.
liz November 11th, 2008 06:39:53 PM
Dr. K - Wow that is a tough one. I think it is professionalism that prevents (some of) us from badmouthing fellow vets. In my heart I think I would be wanting to spread the alarm about this guy but in reality it is not as clear cut. I couldn't tell from your post and and I know this was not a case you had referred to this guy but do you refer at all to him? I would gather not and if someone ever asked your opinion on him then you could be truthful and say that you didn't appreciate his work. That way the clinet brings it up and you could at least raise a question about him. Have you ever tried calling and talking to this surgeon and discussing his cases with him? Do other vet clinics? Or after he cuts them he is totally out of the picture and leaves it all up to the practice to manage? Anyway if you raise your concerns with him then your sort of throwing the ball back in his court; letting him know that someone is watching and monitoring. Document all communications and if things don't improve then I would inform him that I will be reporting.
Jessica November 11th, 2008 07:28:47 PM
If I am interpreting the post correctly, this is not just a matter of "not recommending" an unqualified or "bad vet", this involves sort of a "ring-like" cooperation among a select number of clinics....that choose to offer this "inside special surgical service" so that the "home-based" clinic reaps the reward of supportive services.....hmm, sounding all to familiar to me, in my home state. But, I do feel the need to preface, that years ago, before all the free-standing "ER & large referral hospitals" sprung up, having a specialty surgeon, particularly for complicated fractures or tissue surgery come to a client's clinic to operate on a patient was not unusual nor meant something 'bad'. So the drift I get here is that there is a bit of "automatic protection" involved. To suggest that "one or several" vets will not recommend him is a watered down version of nothing at all; this person already has his "client base". A similar type thing that I've dubbed the "end-of-life scam" ivolves cooperation of an entire group of people to be successful, I can only wonder what the fee split is. "Pocket's Story from NH" http://walnut-hill.bravehost.com
Barbara "Pocket's Story from NH" November 11th, 2008 09:14:19 PM
Is it just me or is there something ethically lacking in this situation? This seriously troubles me when cases like this come up. Yes, you could possible be sued for defamation of character, but shouldn't somebody speak out against what happened? I am not saying it is your job, I mean the last thing we want is to pin Vet vs. vet in a confrontational situation such as this. However, I think such situations do need to be adressed somehow. The vet industry is still very much a work in progress (especially in terms of technicians and forming a credential process. Can the vet industry really afford having lilabilities like this vet in question? To further our industry it seems to me we need some sort of fair system. What this is, I don't know. But, one that will take care of such grevences in a fair and impartial manner, and one that one end up just pitting vet against vet. I had a similar situation today... I had a client call, and tell me that the dog at 7 months was still acting up and destroying things in her house...e.g carpets ect. She wanted to get tranqs for the dog which I tried to persuade her away from ( as the situation sounded more behavioral /puppy problems then seperation anxiety. ( I took a call back message for our Doc, and refered her to a well -known local dog trainer in the mean time to help her trouble shoot. She further informed me that she had already spent $500.00 getting the dog "trained", and did not wish for further training. It sounded like to me that this trainer didn't know jack and made a minimal difference considering that the puppy is still wild and the owner lets her walk all over her. Of course I did not tell her this, but in the back of my head I am wondering "What kind of half ass training did this so called "trainer" put the dog thru?"
ed November 11th, 2008 10:34:54 PM
Okay, I have been reading your blog for about a year and I can't get enough of it but usually don't post anything. I not really the type of person who wants to be heard unless I feel strongly about something. To save you the long version, my baby had to have hip surgery (FHO)before he was a year old and the vet completely botched the surgery. When I say botched I mean he left the femoral head in the socket and actually broke the neck of his femur. Oh, did I forget to mention that somehow the femur was repositioned so the jagged end of his femoral neck was grinding against his hip (ilium). He was recommended by a friend who was a technician. I had heard one bad story about him but she assured me that it was false. I should have known and listened to my instict but instead I trusted a veterinary professional who dearly loved animals. How could she be wrong? Well, for a month after the surgery I looked into my baby's eyes and saw the pain. Let me tell you I never want to ever see that again. The point is, people are trusting you to do the right thing. Yes, you have to be careful and you have to be sure this vet didn't just make a mistake but it sounds like there is a long track record to back up your concerns. I agree with many of the posts that you don't need to get a megaphone and scream this vet's name out in rush hour traffic but you have to let him and the people who employ his services know that this type of work won't be tolerated. Didn't you just post about cheating in vet school? How is this any different? Why wouldn't Veterinarians stand up quietly and let him know they are watching?
chris November 11th, 2008 10:35:16 PM
And people say lawyers protect each other? Do vets not have somebody at the veterinary board they can contact with ethical questions like lawyers do?
I would ask my lawyer how to handle it, then possibly do B. You owe it to the profession, especially if this guy's work keeps cropping up.
Tracy November 11th, 2008 11:06:57 PM
Option a: Here in Alabama you can’t even get a vet to have an unofficial opinion about another vet. . .it’s a brotherhood. . .a closed society. . .all for one and one for all. Option b: The Board is composed of VETS. . .refer to option a. In addition, they have legislated all their actions, even routine board meetings to be confidential information. The consumer has no way of getting any information from the board, not even FOIA applies to the Board! I’ve read the Alabama statutes and can’t even find a requirement in them for the board to represent the consumer/patient. Option c: I’m sure this is old news to the owner at this point. Option d: Sure, might as well profit from her grief and desperation like those vets before you. Option e: Amputate the leg at your cost. Then get off your duff, contact your legislators and be part of the solution to improving animal law and making yourselves liable for what you do just as medical doctors are. al-vetboardwatch.110MB.com
Fotini November 11th, 2008 11:07:23 PM
We trust in you, or any medical professional we choose, to DO NO HARM. By staying silent you would be complicit. I do hope there is a medium for you to lodge a complaint.
clover November 11th, 2008 11:15:57 PM
There was a vet who kept messing up in my hometown when I was a veterinary assistant. He was an older GP, and one clinic I worked for cleaned up after him several times that I knew of. I remember a couple with two pit bulls who brought them to us coughing blood--spattering the floor with it. Their dogs had heartworm, and Dr. Soandso had told them they didn't have to worry about treating it until they started coughing blood like that. Why they came to us instead of him for the treatment, I don't know. It seemed that every vet in town knew about this man, yet nobody ever did anything about him. He kept practicing until he retired comfortably. Really, what on earth can be done about this sort of thing?
Laurel November 12th, 2008 05:48:36 AM
What "credentials" impressed the owner? Did Vet A misrepresent himself? If so, that, if nothing else, ought to be reportable and punishable.
Other than that, it seems to me that at the very least, you should be able to tell the owner, in all sorts of detail, what you would have done differently, if the dog had been your client. That would give her the information she needs to file a complaint, without getting into a potential "Vet B says that Vet A did X, Y, and Z wrong" ethics dilemma.
Shelly November 12th, 2008 07:27:52 AM
Because state vet boards are almost uniformly unhelpful (to put it mildly) to pet owners complaints, bad vets know that even if the media and other vets do announce shortcomings (to put that mildly, as well), generally nothing will be done, although they may have to pay a fine (which is almost always meant just to pay for the paperwork involved). For them it becomes "just the price of doing business" and they probably even factor it into their prices. A vet here in Ohio has situated her clinic so close to a real emergency/specialty clinic that people go there accidently and the care recieved is often abysmal (abusive in my estimation). Even though many voices have spoken out - and she's had to pay several thousands of dollars in fines - it's impossible to reach all the people who might go there, unknowingly. Even the vets who won't speak against others sometimes tell their clients outright "Make sure you go to the stand-alone white building, not the one next to the ********'s", and will make sad faces and shake their heads when this vet's name is mentioned, so although it's nowhere near enough, it's more than they'll do about other vets. I wish there was a mandatory inspection (such as the health inspector for restaurants) with a mandatory grade just to let people know about cleaniness/record-keeping practices. I realize that actual care/diagnosis work can be subjective, and almost unquantifiable because of the many factors involved, but if the clinic isn't clean and accurate, well, that is often the start of the bad practices that might be going on there, IMHO. I do applaud the few websites around that have 'ratings' for client use - although there sometimes are individual bad reviews of a good vet (no one can please everyone), if there are many good ones, or many bad ones, it can be helpful. I understand Angie's List is now putting up people's reviews of (human) doctors. Maybe that would be a place to consolidate vet reviews sometime soon.
Kate November 12th, 2008 11:50:48 AM
I think it's a really complicated issue, even if you don't consider the possible consequences amongst colleagues and within the profession if you were to "rat" this guy out. First, said history was obtained from owner - I'm not suggesting that the owner intentionally lied or that there's just reason to discount everything she says, but it's pretty difficult to take owner-supplied histories at 100% face value. There are so many things that tend to go over most owners' heads given their lack of veterinary knowledge, and sometimes owners gloss over seemingly unimportant details - like failing to follow through 100% w/discharge instructions. There could have been legit reasons for why the repairs failed or unforeseen complications during the procedure that may or may not have been relayed to the owner - although if there were, they should have been. Maybe the owner really didn't like the idea of amputation (at the time) and it was a hope-for-the-best situation that just wasn't going to work. Finally, it's not really a crime to do crappy veterinary work - otherwise, half of the profession would be out of a job. It is unethical to intentionally render substandard care, to practice below a profession-established level of care, or to falsify medical records...but can any of these things be proven?. Maybe this guy really thinks he's a rock star and isn't aware of his complication rate b/c he never follows up with the patients he's worked on. Is his complication rate really any higher than any other surgeon's? Or, since you already have the idea that he does crappy work, do his transgressions tend to come to the front of your mind easier? Maybe he really is the devil in a surgeon's cap and gown, cutting corners and doing crappy work and laughing all the way to the bank. It's certainly easier to believe. But, none of this changes the fact that you have, sitting in front of you, a dog with a non-functional joint with little hope for repair - amputation is obviously what needs to be done, and the dog will probably do well on three legs. Luckily for him, I believe dogs live "in the now" - once he's running around on three legs, he probably will have little recollection of the suffering he went through with the one, at least not on a conscious level. The owner is out a lot of cash and that's unfortunate, but "buyer beware". I know it might seem tacky to use that phrase in this situation - I'm not ignoring the possible wrongdoing that may have occurred...I just think people need to be more careful, even with their vets. Do your research. Empower yourself to ask for a board-certified specialist.
anna November 12th, 2008 01:36:48 PM
It is unethical to intentionally render substandard care, to practice below a profession-established level of care, or to falsify medical records...but can any of these things be proven?. Maybe this guy really thinks he's a rock star and isn't aware of his complication rate b/c he never follows up with the patients he's worked on.
It's unethical to cover up for the incompetent, even when their incompetence is entirely "innocent', and even when they are filled with delusions of greatness. If this guy screws up badly, with bad consequences for patients and clients, often enough that Dr. Khuly is not surprised to hear his name attached to another screw-up, that she expects to hear his name in that context, it is absolutely wrong of her to not at least point out to the clients that they have the right to file a complaint.
We pay veterinarians for medical services for our pets because we are not veterinarians ourselves. And people who are sufficiently uneducated that they don't even know that "board-certified specialists" exist, much less when they should ask for one, but who do take the pets to the vet to seek the care they need, have the same right to excellent care for their pets that those board-certified specialists have to excellent care for their pets.
Lis November 12th, 2008 03:25:11 PM
Anna, I agree with you that helping the dog in the present moment is Priority #1. But I find your statement "it's not really a crime to do crappy veterinary work - otherwise, half of the profession would be out of a job" very scary, and in spite of your assertions that you are not ignoring wrongdoing, I find them dismissive. Also, there is an inherent contradiction in your argument. One the one hand, you say the client may be misunderstanding or misrepresenting things due to lack of veterinary knowledge. On the other hand, you are implying that the owner didn't do his/her research, and should have asked for a Board-certified specialist. How is this unsophisticated client you paint a picture of -- who can't grasp veterinary concepts and fails to understand what's important -- know enough to ask for a board-certified specialist and do their research . . . unless their vets help them understand this? Ah, but instead, their vets are REFERRING said clients to this guy for not very ethical reasons having to do with making money off follow up care. And those clients are listening to their vets, trusting them, and going to this guy. You expect these poor little naiive and simple minded owners lacking any veterinary understanding (as you paint a picture of them) to figure that out? Then you pretty much place the blame at the clients feet when the vet -- whose track record Dr. Khuly explains -- does shoddy work and apparently does repeated unncessary surgeries due to said shoddy work? We are darned if we do, darned if we don't, out here in client land. You want us to "comply" and blame complications on client lack of compliance or failure to mention important things. Then, you blame us for listening to what our vets tell us and going to the guy they send us to instead of knowing enough to seek a board certified specialist? Way too many people in your field are full of excuses, full of blame (for the clients) and totally absent any kind of sense of professional accountability. It's a rather pervasive attitude. Blame things on the owner -- including the sloppy work of vets. After all, we were dumb enough to trust the guy, right? If that's true, then the wise thing would be for us to trust NONE of you. (Because how in the world will we have the sophistication to tell the good from the bad? We don't.) But beware. If we trust NONE of you, then we won't be very compliant -- we will likely do our own research. And there will be lots more complaints when things go wrong. And of course, the vets that get filed on will blame it on the clients, people with you attitude sitting on vet boards will clear the vets, until we have no choice but to seek to make the joke of veterinary regulation a major news story, or die trying.
stefani November 12th, 2008 03:35:44 PM
Not all states allow vets to report other vets.
Sometimes clients versions of what happened differ from reality. Sometimes clients don't follow discharge instructions.
Unfortunatly, because its really hard to say what actually happened in a lot of cases, its really hard for vets to speak out against percieved malpractice- even if it seems glaringly obvious.
Dr. Patty, it sounds like you don't have the previous records on this animal? I don't doubt your judgement, but can you say for sure that the client followed every dishcharge instruction, made every follow up appointment, etc?
Alli November 12th, 2008 05:39:04 PM
Lis, I do agree that client's deserve the best care for their pets regardless of their education, and when I wrote about the diffculty of proving intent to render substandard care, I wasn't implying that such a thing didn't happen. It does happen. The question is, what do you do if you can't prove it? I apologize if my post was poorly worded in such a way as to imply that I blame the client. I don't know enough about this particular situation to sufficiently place blame anywhere - after all, even though I enjoy reading this blog and value Dr. K's opinion (as much as one could without having actually experienced a client-patient-relationship with her), it is simply her opinion, and even she is one degree removed from the situation b/c she's seeing these patients after much time and treatment(whether correctly rendered or not) has passed. And that was my true point. I don't know who's to blame, and I don't believe anyone else can be 100% sure if they weren't directly involved in the scenario. That's what makes it complicated and difficult. There are so many variables - on both the veterinarian and the client side - and that's why I believe so many vets have difficulty in this situation. I was merely trying to illustrate some of the potential variables - like I said, maybe Dr. K's right on the nose. But maybe not. I stand by my statement that it's not a crime to do crappy veterinary work. I'm not saying it's right, and I certainly would not work for a veterinarian who knowingly did a piss-poor job. But the fact is that just b/c Dr. K feels another vet does crap work, even if others agree with her, and even if it's true, legally there doesn't seem to be much recourse. She can, of course, make sure she refers her clients elsewhere. But telling the client that her pet's current condition is a direct result of some other vet's poor work and encouraging that client to seek some type of recourse is not a black and white issue...which I think is the point of her post. To Stefani - an unsophisticated, naive, dumb, simple-minded client who can't grasp veterinary concepts and fails to understand what's important is your description, not mine. Please don't put words in my mouth, and don't presume to know enough about me to state that "people with my attitude" would clear vets of wrongdoing even if they were guilty. It's clear that you and I have differing opinions on this post, but there's no need for you to direct that kind of tone towards me.
anna November 12th, 2008 05:40:25 PM
Even if the client didn't follw all discharge instructions 100% -- that doesn't explain away what Dr. Khuly has observed in this case. Nor does it provide a legitimate "out" for the vet's questionable (and questioned) work. An argument we often hear from vet boards and disingenuous insurance company lawyers is often much like that: Find one small flaw in the clients behavior or story, and completely throw out the allegations. It flys in the face of common sense, it's more of a nudge-nudge, wink wink, thing. Come to think of it, the vet boards don't even need that excuse.
Stefani November 12th, 2008 06:24:23 PM
When someone says "do your homework", I become completelt baffled as to how that is supposed to be achieved? Especially, when it is pretty well known that prior complaints are sealed from public view. So what is one to do? Ask the friend or co-worker that often thinks veterinary care consists of annual vacs and stool samples? Just where is this information supposed to be? As far as "board certified" with numerous intials after a DVM, well several of us have found out the hard way that titles are meaningless. As far as clinics go, looking around can be an indication, but not always. And bad care is a "crime", there is a standard of care for every profession and when it falls below and becomes "bad" and money is charged for it, it is called numerous things: fraud, bilking, cheating, stealing, etc. ; just the same as if a mechanic charged you for shoddy work or something not done at all. Same as a medical professional committing shoddy work, a "license is a PRIVELEGE" not an automatic piece of paper when you pay a fee. Thank you to all the posters for candidness, sharing experiences, and the lurkers that felt strongly to post. There is a growing grassroots group that is working very diligently to change the system from the outside, thru legislation, judicial, and public awareness to benefit all companion owners with a realistic expectation of quality and ethical veterinary care. Visit www.vetabusenetwork.com And I thank Dr. Khuly for providing the many blogs that allow us to exchange ideas.
Barbara "Pocket's Story from NH" November 12th, 2008 06:42:21 PM
As much as specialists have been a blessing in the veterinarian industry, it has spawned many of the same problems we face in human medicine---mainly that no single doctor looks out for the ailing patient and we're left to do that on our own with whatever resources, knowledge and chutzpah we possess. I admit to getting slightly peeved when hearing of 'dilemmas' such as this, particularly when I'm only given the 4 choices you have offered, and I want another. I would request a release from the client so that I can get all records, x-rays and any other related documents transferred from the prior hospital. I would review those records thoroughly--it seems these folks were actually taken advantage of on numerous fronts. Then I would pick up the phone and call the surgeon and the managing partner of the clinic and in very plain and explicit language explain your quandry with both this and other clients, even perhaps send them this newsletter. Let them pick a letter. Sometimes a good dressing down will make people think twice about committing unacceptable acts in the future. Because, quite frankly, while giving your client a break on the price for fixing this horrid problem was both kind and generous, I'm not willing to let you off the hook that easily. I've been that client too many times before, and since telling that client the very real truth puts you in a delicate legal position--particularly in s. Florida (been there, too)--calling up the yahoos that are doing this damage daily will potentially make them better vets. And heck, you'll probably feel better, too.
Laura November 12th, 2008 08:50:52 PM
Alli: "Sometimes clients versions of what happened differ from reality. Sometimes clients don't follow discharge instructions." Wrong!!!!!! http://alabamavetboardwatch.110mb.com/
Fotini November 12th, 2008 10:26:46 PM
Here's an update: The owner is not interested in pursuing anything--she volunteered this information herself. She blames her own "dishrag" responses (as in, she thinks she allowed herself to be abused) and wants it all in the past. As long as she has a healthy cat she's happy. And he's doing great after the amputation.
I did, however, speak to a couple of specialists who know his work as well as with my own in-hospital colleagues. All seem to feel that it's not my place to get into it. They believe that because the system is so flawed the repercussions from any such complaints are potentially huge. Currently, the system allows for market forces to play themselves out (Enron, AIG, Coutrywide, anyone?). Instead, they suggest I get more involved in the VMA at the state level to push changes along. Doing anything more direct would hurt me disproportionately considering that current market forces favor this vet tremendously.
Sad. But there is a silver lining: The opportunity to make broader changes at a higher level.
Dr. Patty Khuly November 13th, 2008 08:53:31 AM
Alli: I hear you. I know I don't have all the details. I suspect the owner shares some degree of blame. But the physical evidence doesn't lie. Someone did a below-standard of care job on this animal. And I saw the invoices. Someone also charged her above market prices for the work.
I didn't mention it in this post (though I've posted on this before), that I've also had the misfortune of working in a clinic that used this vet's services. Though I like this man and met his family and have respect for him as a person (I think he believes he's offering the community an excellent service) I was fired for refusing to offer his services to any of my clients. In fact, when other doctors in the hospital did refer to him I always found a way to let the clients know they had other choices. Most of the time the clients would select the boarded specialists across town.
I tell you this so you know I don't come at this problem from an arm's length, second-hand perspective. I actually saw some damage done first-hand. And I could kick myself for not doing more when I had a real opportunity to make some changes.
Dr. Patty Khuly November 13th, 2008 09:03:29 AM
Re: "All seem to feel that it's not my place to get into it" Well, I understand the position you are in, and I hope you can make changes via the VMA. But I also think this attitude is a major contributor to the problem, and its an elaborate rationalization. Conscientious vets know that the regulatory system is broken, so the argument is . . . "The system is broken, don't bother going through the system" . . . ?? This discussion tells me that conscientious practitioners, when they are aware of a problem vet, will not report them (for whatever reason, even if it's lack of faith in the system). I am happy to have read this candid thread, because it only underscores the fact that I, and others, are doing the right thing trying to get clients to be skeptical and report vets, as consumers. Even if it makes me persona non grata with conscientious vets, who I appreciate. I will hate for that to happen if it does, but I realize that it is a price I may pay. The day could come when I have to hire friends to take my cats to the vet because no one will help us because of my outspokenness on this issue. Particularly since good vets don't seem to believe in reporting bad ones. Hmmm. This has confirmed that I am doing the right thing. I believe that while vet boards do, in fact, suck, they will never NOT suck unless we KEEP reporting incidents to them, and when valid cases are thrown out, we will gather information over YEARS on this lack of enforcement, and go before the Sunset Commissions. Write our state representatives. Go to the press. We're not talking about yanking licenses away from vets for one mistake, or even one mistake a year. It's true -- you are human. We're talking about getting rid of the people who practice shoddy veterinary medicine consistently. Or are negligent and careless, consistently. And for those who are negligent in certain cases, the punishment (even one-time-only) should be significant enough that it helps motivate them to change. For crying out loud, the vet boards should at LEAST enforce all these suspensions they issue but consistently "stay." I don't really understand clients who just want to let this stuff drop. I believe people like that are indirectly responsible for what happened to my cat, and the injuries of so many others. I believe it is selfish and irresponsible NOT to report dangerous practices. I am not talking about one-time mistakes made by otherwise conscientious individuals. I'm talking about things that point to a pattern. Failure to report that is socially irresponsible, to me. Complicit.
Stefani November 13th, 2008 09:42:04 AM
I thought it was this woman's dog, not cat?
Creature of Habit November 13th, 2008 12:26:35 PM
If only the repercussions of referring to him were potentially huge... Does the clinic where the surgery is performed bear no liability when a more assertive owner files a complaint since it occurs at their site? I hope that you will find every opportunity to bring this case to colleagues' attention, especially the ones who support his work. And if he's such a nice man... why not bring this particular case and your view of the work to his attention? Our biggest failure as owners, in my opinion, is failing to address malpractice through any channel available to us. If it doesn't help, well, at least we did our part. And certainly no one will be held accountable if we don't hold them accountable.
Natalie November 13th, 2008 01:27:03 PM
Creature of Habit: Oops! I usually change identifying details so I don't get into too much trouble should the guilty parties (or affected individuals happen upon my blog). Problem is, I've a horrible memory for these things. As you can see, I'd make a terrible liar, too. ;-)
Natalie: I have brought this to the attention of several practice owners. The only problem is that the ones who use him love him and think he can do no wrong. The ones who don't have either been "burned" or reject that kind of medicine already (and agree with me).
Dr. Patty Khuly November 13th, 2008 04:14:42 PM
Just FYI, I talked to the Florida Board today. They do accept anonymous complaints. But of course, they will only follow up on those that meet whatever criteria they have for "legal sufficiency" and not submitting any records would make it less likely to meet the legal sufficiency burden. It would be hard to stay anonymous while submitting your own records of care for the animal (which would probably be enough to establish legal sufficiency, but I can't say for sure). It is also true that you do NOT have to be the client (i.e., aggrieved party) to file a complaint. Again, not having records weakens it, but you as the next treating vet DO in fact, have records that are relevant, and you COULD file.
Stefani November 13th, 2008 05:14:56 PM
This woman wants to put it "all behind her" after spending $10,000? She must be awful wealthy to consider this "chump change" woweee.... not to mention either a bit ignorant and certainly not worried about other poor victims of same abuse.
Barbara "Pocket's Story from NH" November 13th, 2008 05:40:46 PM
And here in lies the problem...NO ONE WANTS TO GET INVOLVED....
No moral or ethical problems with not doing anything?
This is the #1 problem.
LorriM November 13th, 2008 11:37:10 PM
I was wondering: if the law did not see animals as "mere property" but as "sentient beings," would you have posted this article? Would some veterinarians act as irresponsibly as they repeatedly have? Woof, Woof, your Honor! http://alabamavetwatchboard.110MB.com
Fotini November 14th, 2008 01:01:33 AM
I'd like to think that those who think he can do no wrong could see in this case that, in fact, he can and does. Still, unless we as owners make the complaints, we just shuffle the ethical and moral dilemmas onto others - two-legged and four-legged - and insure that yet more animals will suffer as a result.
Natalie November 14th, 2008 05:53:40 PM
We lived for a number of years next door to a neglected and consequently dog aggressive pit bull. When we had problems, we filed them with Animal Control, including the day she attacked us across the street from her home and ours. We escaped only because someone else in the neighborhood was able to back her off long enough for my dog and me to get safely inside. In that case, we asked for punative measures - a fine was all we could get - to pressure them to better contain the dog. ------------ But when a tiny chihuahua across the street was outside her front door barking a few months later, the pit bill tore out the door at the first opportunity and attacked her, causing fatal injuries. The chihuahua's owner did not bother to file a complaint with Animal Control. And as a result, we dealt with that pit bull for three more years as she tried to break down the fence between our yards to get at our dog. Several more complaints had to be filed with Animal Control before they moved away. ------------ Our neighbors had the opportunity to make a difference - the attack on their dog would have been enough to generate serious action. They couldn't be bothered...
Natalie November 14th, 2008 06:00:24 PM
(1) I am totally jealous by all of your comments. I think you have more comments on this one post than I've ever had. :c)
(2) I stopped reading when I got to:
a) Call the Board of Veterinary medicine and lodge a complaint.
This is the right thing to do, despite your caveat that it's not open to you. The goal is not to file a successful greivance against this doctor, the goal is to add your EXPERT opinion that the work is shoddy or the recommendations made by other doctors are inappropriate, and the PATTERN OF BEHAVIOR that only you are in a position to take note of, and make sure that the people who should be informed are informed.
If they have a handful of open cases against this Doctor, then they now have a phone number to call to get more testimony if need be... from you or from the client.
This is the smell test to me... if you were taken to the cleaners by this Doctor as your client has been, and you were later told about how you've been making your vet and the surgeon's car payments with return visits and additional proceedures... and that this surgeon's work is poor enough to be known in the business... WHY hasn't SOMEONE done something.
Well, who is the someone? Individual clients can be written off and fought as anomalies or blamed for their lack of care or some other technicality that takes the focus off of the pattern of behavior. It's also easy to dispiss the lone client because they were ignorant enough to be duped so many times and they also have an emptional investment that will not appeal to the board. The issue here is shoddy work, and the client is the least able to speak to that aspect.
They can talk all about how it happened, the pain, their love, the sad story... but they are the least credible on > did the surgeon make the right call to do the surgery, and was it done correctly <.
I'd make a call to the vet who referred the client to the surgeon and ask about their impression of the work and give them yours. Nothing like peer pressure.
Christopher Landauer November 17th, 2008 07:03:29 PM
Dr. Khuly, you and your fellow respectable vets are in a unique position to know the goings on of this guy. No one else really could know the extent of his improper care - many owners, if they do become aware of botched care with their own, probably attribute it to a one-time offense. I know I would try to give my vet the benefit of the doubt, and understand everyone can't be perfect all the time. You and those in your profession are in this unfortunately unique position of being the only ones likely to be privvy to what's happening. That and the known risks involved also makes your complaint much more potentially potent than that of a single pet owner's.
So, with that preface, I ask, who's place IS is to "get into it"?
Who else could know what you and your colleagues know?
You and your colleagues may believe it's not your place (I understand, but idealistically, I strongly disagree), but you and yours are the only ones who can do so and have a fighting chance of stopping the suffering this guy is causing in both animals and their people.
Erin November 18th, 2008 12:50:25 PM
First off... HEY DOC! I miss you, I hope all is well I'll be passing by the office soon! But man, Its actually quite weird at the practice I work at we had a second opinion come in with the same type of orthopedic complications come in, but no surgery was done yet, just pricing that was outrageous and literature on how the DVM was going to fix it... very scary. But anyways, I would go with all of the above... Down here in Miami we unfortunatly have alot of fonny vets and this mal practice is getting out of hand for all the other vets having to fix these complications and the pain our patient are having to go through. The dog will have a great life having 3 legs, getting the sx to fix the problem will be great but probably take about 5 years to full recovery if not even a full recovery. The owner obviously loves the animal dearly, and she will be paying double if not more for the sx plus rehab. Good luck doc, im sure you'll do what is best.
Michelle RVT November 19th, 2008 07:13:17 PM
So...nobody is going to do anything. BIG surprise. I think we should all take a minute and think about the future animals who are going to be "treated" by this creep. They may not be sick yet; heck, they may not even be born yet. But make no mistake - he will have future victims, and he will have them because somebody wanted to put it behind them, didn't want to get involved, and didn't want "repercussions." After the creep here put my dying, dehydrated CRF cat in a box and gassed her without presurgical labwork or owner notification , only then did I discover the trail that went back at least 20 years. Everybody I talked to about this miserable excuse for a "doctor" had an excuse as to why they "couldn't" take any action. Cowards. Every last bloody, stinking one of them. If even ONE of them had spoken out -- as I do now and will do for the rest of my life -- I might have been able to avoid the senseless tragedy that Suki went through. I can only hope and pray that every one of those lily-livered jerks ends up with a doctor for themselves, their elderly parents, their children, or their grandchildren EXACTLY like the one that they "couldn't" do anything about. It would be karma at its finest.
Julie "Suki's Story" Texas December 1st, 2008 12:10:00 PM
how do i file against my local vets?
jennie December 4th, 2008 04:45:56 PM
That is it in a nut shell. Cover your own butt. Forget about the oath and the client. Good thing you were not the client.
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Interesting. I've been on the other side of this. A therapist referred me to a colleague for group therapy. She didn't give an endorsement and made it clear that she knew this person only through professional associations. The second therapist did some things in the group that struck me as inappropriate based not only on my gut but also on my own concurrent graduate training as a psychotherapist. When I told therapist #1 about the behaviors of therapist #2, her response was: "That sounds actionable to me."
I believe she had the same dilemma (less severe a case actually) as you report here. She had no direct experience of this man's ethical breaches. As a therapist, she also had a need to avoid "drama" in our relationship. Her tone was very clear, though. I got the impression that she believed somebody should take action, though she was not pushing me to do so.
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