Business Briefs: Preventing Malpractice Claims in Equine Veterinary Medicine

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PPEs generate highest number of Malpractice Claims
Pre-purchase exams generate the highest number of malpractice claims for equine veterinarians. Daisy-Daisy/iStock via Getty Images

The AVMA’s Professional Liability Trust (PLIT) has handled many malpractice claims over the last six decades. Their records have allowed the Trust to identify four key principles that veterinarians can utilize to lower their risk of having a malpractice claim or a board complaint filed against them. Dr. Cynthia McKenzie shared these principles at the 68thAAEP Annual Convention.

The first principle is to always create complete medical records that accurately document every case. The second principle is to follow best practices for diagnosis, treatment and follow-up. The third principle is to ensure safety to the best of your ability for patients, clients and team members. Finally, the fourth principle is to communicate clearly, frequently and accurately with all appropriate stakeholders. 

Principle One: Create Complete Medical Records

According to McKenzie, a reviewer of PLIT equine malpractice claims, “equine veterinary medical records have historically contained less information than what is required by most state licensing boards.” Due to the increasingly litigious society in which we live, there has been an increase in both malpractice claims and board complaints. As a consequence of their poor medical records, equine practitioners are often at a disadvantage if they have a lawsuit filed against them or are subject to a veterinary license defense claim.

Requirements for Medical Records

Medical records document examinations, diagnostics, treatment and communication. By law, they should be accurate, legible, clear and timely, whether handwritten or digital within a practice management software information system. Minimum requirements for medical records vary from state to state based on the state’s veterinary practice act. However, most experts in the field recommend a SOAP (subjective, objective, assessment, plan) format. Practicing in an ambulatory setting does not relieve the veterinarian of the requirement to have complete medical records. Check sheets or invoices do not meet state requirements. If a veterinarian is licensed in more than one state, the state with the most stringent requirements should be the standard for that practice’s medical records. 

Role of Medical Records in the Courtroom

In a courtroom setting, the medical records will show the practitioner’s attention to detail. If it isn’t written down, it didn’t happen, according to most judges. Because continuity of care is so important, any equine veterinarian who reads the medical record should be able to understand the case, the diagnosis and the treatment performed or prescribed. They should also make appropriate decisions for continued management of the case. A fully complete record should contain findings of every examination or diagnostic test, every treatment given, anesthesia reports, surgery reports, any declined recommendations, all consent forms, and a comprehensive communication log. 

Complying with State Laws

Each state’s practice act describes its expectations for medical records. Veterinarians should know the laws that they will be held to if a malpractice suit is filed. Good records take time, but they are the best defense against a legal case. Most states define timely as within 24 hours, so doctors must write records contemporaneously, not at the end of the month from cryptic notes in a daily diary.

Principle Two: Practice Good Medicine

Practicing good medicine requires staying up to date by reading journals regularly and attending continuing education on an annual basis. Veterinarians should incorporate new ideas into medical routines, anesthesia protocols and pain management strategies. Keeping technology up to date follows the same principle. 

Principle Three: Ensure Safety for Patients, Clients and Staff

To have a strong safety record, practices should be attentive to any accidents or close calls and take corrective action. Personal protective equipment should be available, and its use encouraged or mandated. Leaders should model the way by using this equipment to normalize its use. Clients should not handle the horse during the veterinarian’s work unless there is no other choice.

Principle Four: Communicate Clearly

At the 2021 Annual AAEP Convention, Nina Mouledous, DVM, Trust Veterinarian for the AVMA Professional Liability Insurance Trust (PLIT), shared that, “The most common and costly equine malpractice complaints involve buyer complaints related to prepurchase examinations (PPEs).” She further revealed that the top six claims involve PPE, rectal tears, castrations, anesthesia recovery, consent issues and injection complications. 

PPE Malpractice Claims

Lawsuits concerning PPE claims often center around economic loss due to lameness of the horse that the veterinarian examined prior to purchase. These complaints are often accompanied by missed radiographic lesions. When PLIT payouts are required, records show that 80% are for lameness and radiographic misdiagnosis. Missed radiographic lesions command the highest sums. Other PPE complaints are associated with undetected heart murmurs, missed ophthalmic disease, unobserved surgical scars and failure to recommend genetic testing. 

To avoid these negative PPE outcomes, veterinarians need to steer clear of conflicts of interest. They should attempt to positively identify the horse and accurately estimate the animal’s age.  A comprehensive report should include documentation of these steps, preferably with identifying photographs. The report should indicate that the veterinarian has examined all systems, with commentary included on all radiographs and ultrasound images.

Taking steps to prevent misunderstandings through clear communication, creating complete medical records, remaining up to date in medicine, and eliminating as many risks as possible will prevent the majority of malpractice claims.

Disclaimer from Sponsor

This content is subject to change without notice and offered for informational use only. You are urged to consult with your individual business, financial, legal, tax and/or other medical providers with respect to any information presented. Synchrony and any of its affiliates, including CareCredit, (collectively, “Synchrony”) makes no representations or warranties regarding this content and accept no liability for any loss or harm arising from the use of the information provided. All statements and opinions in the article are the sole opinions of the author. Your receipt of this material constitutes your acceptance of these terms and conditions.

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