TECHNICIAN UPDATE
RISK in the Equine Practice: The Technician’s Role in Recognition and Prevention By Deborah B. Reeder, BA, AS, RVT, VTS-EVN The most important area to address in management is risk, which can involve safety issues, legal problems, claims against the practice from clients or employees or co-owners, to the public. Yes—the equine veterinary practice does have an impact on public health . . . Is your practice prepared and protected? Why is the equine practice a unique potential for risk? There are many reasons. For instance, we often receive instructions from trainers, not the actual owner. It is sometimes difficult to determine who makes the financial and medical decisions for the horse (syndicates). There is a resistance to pay at the time of service. It is just the nature of the horse industry; it is full of risk. There are unrealistic expectations. And through all of these, technicians play an important role because we often wear many hats. We can be asked to do what may be questionable ethically, legally, beyond our skill level, or potentially against policies and procedures. So how to we identify risk? The first discussion is of course the legal one. What constitutes malpractice and how do we avoid it. The three C’s of malpractice are: Competence, Communication and Compassion. If you are above question in these 3 areas, you can usually avoid malpractice issues or risk. Animals are considered property, however, sentimental value is coming soon to a court near you. To show that a veterinarian or member of the staff has exhibited professional negligence, someone must prove that there has been a lack of duty of care, a breech of that duty and damages. One of the key areas in which a practice can prove competence is to show that it supports the staff in participating and attending continuing education (CE). If the technician staff is competent (i.e., trained and attends regular CE) the risk is lowered, and there is less likelihood of someone proving negligence. Communication to the client and among staff is a clinical skill that is often overlooked, and probably the most common cause for complaints and increased risk. Make sure that clients are fully informed of all procedures, costs, risks associated with any of the procedures or medications, the best and 16
Issue 12/2020 | ModernEquineVet.com
worst case scenarios, the doctors and staff involved in the care, the hours of care, and verifying that the clients understand all they were told or read. A nod of understanding in a moment of fear or financial paralysis facing a colic surgery is not enough. Informed consent is not just a signature on a form, it is a process of dialogue. Another important issue to avoid litigation is demonstrating how much we care. Compassion for horses is why many of us are in this field, and yet with the harried hours, the rush to get to surgery, the overwhelming caseload, the fear that it might be too late, or the lack of confidence in a definitive outcome can often be interpreted as not caring, being short, cold, or profit driven. Communicating compassion is key to the client, to the owner, to the daughter, to the husband trying to understand. It is our responsibility to provide it along with the best medical care we can. Be candid when something goes wrong. Talk to the client directly and honestly. Keep accurate notes. Advise staff not to discuss the situation with anyone. Other areas of risk that can be managed in the equine practice involve the consent forms and the estimates.These are absolute musts. They must be from the owner and they can be via the telephone—however it needs to be noted as such. The owner must be advised as to any and all risks associated with a medication (especially if it is off-label), and procedures, the nature of the treatments, who will be performing all procedures and treatments, as well as the potential outcome. And the risk needs to be communicated throughout treatment. By law, the consent forms need to be obtained by the veterinarian in charge of the case—to the degree that this is not done, there is risk. Medical records are how you prove in court that you were due diligent and provided the horse with the best care possible. Equine practices need to do better than just the minimum standards if they want to avoid future risk. The records need to be complete, legible, factual, contemporaneous, correct, and they can be computerized. Do a records audit 2–3 times a year. Be the consummate professional when recording, reviewing or correcting the medical records. Will they stand up in a court of law—and can you stand behind them? Written consent and medical records management are by far the most important areas of risk management in the equine practice. If you do these
