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TECHNICIANS 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 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
wrong, you will be destroyed professionally, so will the practice.
Creating and maintaining medi- Teaching Points cal records is the single most important responsibility of the equine HERE ARE 10 PRACTICAL TIPS IF FACED WITH POTENTIAL LITIGATION technician. Make sure they are cor- 1. Take a breath, slow down, respond in a 6. Don’t speak with the complaintant rect, accurate and information is put into the record in a timely manner. Note that any physical images, such as radiographs and ultrasound images, belong to the practice that created them. The information in the professional manner and take the 2–3 minutes to have that conversation 2. Don’t assume that you, the DVM or the practice is in the wrong. 3. Secure the evidence 7. Don’t make alterations in the records 8. Report to your insurer 9. Respond thoughtfully images are the property of the client. 4. Understand the Board Rules 10. Contact a lawyer
States determine how long patient records, including images, 5. Be prompt should be maintained, however, a minimum of 10 years is a good rule of thumb.
Note all conversations, including phone and electronic communications, such as texts. ployee and all potential employees—as well as your in-
Remember this old saying: “If it is not in the medical surance company— go a long way in reducing your risk. record . . . it did not happen.” This may seem like an area that technicians would
One of the most common complaints heard by not have to be involved in . . . and yet, most of the lawyers or before state boards is “I never would have negligence cases reported were directed at or directly consented if I had been informed of the risks.” involved technicians.
The challenges are: We are vulnerable, so we must be diligent. 1. We assume the client understands, because they The best way you can prevent or minimize risk to nod their head or don’t say anything yourself, to your career and to your practice is to be dili2. We are rushed gent in observing where your practice is at risk, take steps 3. We delegate important conversations to other staff to identify those areas, and implement steps to secure who may not be skilled enough to explain systems to stop further risk. Research the State Board 4. We have poor communication skills. (Don’t use Rules and Regulations in your state, find out what the law euphemisms for death and euthanasia as a po- says about your areas of responsibility and level of supertential risk.) vision, as well as FMLA and labor laws. Are you being
The veterinary-client relationship is also at risk. We asked to do things that are questionable or that would put have a responsibility to guard the personal and financial you at risk? Are you being asked to go on salary so you do information of the patient or owner. not have to be paid overtime?
One of the challenges we may face is knowing who the The best defense you have is education. Become inowner is; for instance, in a divorce proceeding, the illegal formed on the laws that could affect and or protect you. possession of a horse, or theft. Do you truly—without a Most veterinarians are not trying to take advantage of shadow of a doubt—know and can prove the ownership you or the law—they simply do not know. Their focus of the horse before you perform a procedure? is on providing medical care to the patient, diagnosing
Another area often overlooked in the equine practice and performing surgery. Your responsibility is to assist is safety. Safety regarding equipment that works proper- them in doing so to the highest standards of care possible, ly—doors, vehicles, stanchions etc. Staff knowing how to which includes minimizing risk for yourself, the client, operate all equipment is a major concern. the patient, the doctor and the practice. Be the difference
There is huge risk involved in working around horses. for your practice . . . it will get noticed. MeV Is training provided on safe horsemanship? Are there signs posted regarding the risk of working around horses, About the Author x-rays, restraint, new surroundings, fear, pain, loud nois- Deborah B. Reeder, BA, AS, RVT, VTS-EVN, is the es—all of these factors play heavily into increased risk. executive director of American Association of Equine Providing a plan showing how you are addressing all of Veterinary Technicians and Associates. these areas in your practice and showing this to each em-
