9 minute read
Recent VPIS Insurance Cases Paul Frazer
Paul Frazer
p.a.fraser80@gmail.com
At the Veterinary Professional Insurance Society (VPIS) we regularly deal with equine insurance claims that arise when our members have, or are alleged to have, made a mistake. There are always lessons to be learnt from these situations, and we thought it would be beneficial for all equine veterinarians to have access to the knowledge gained from others’ misfortune. With this in mind, VPIS will regularly update equine veterinarians with cases dealt with, and the lessons learnt.
CASE 1: VACCINATION MIX-UP PRE-EXPORT
Three horses required vaccination for Strangles and Influenza prior to being exported to Singapore to comply with Singaporean import requirements. The timing was such that it was over the Christmas period and some staff were on holiday. The prescribed vaccination dates were entered into the practice computer system.
The flight schedule changed, meaning the vaccinations would need to occur sooner than scheduled. The practice was notified of the change; however, this information was not passed on to the veterinarian handling the case. As a result, the horses were vaccinated on incorrect dates and had to miss their scheduled flights and be retained in New Zealand until another flight was scheduled. Costs were incurred for this delay.
Our insured was liable and VPIS compensated the shipping company for the carry over costs.
• Lessons learnt: There were systems errors on the part of both the shipping agents and our insured.
The vet practice has changed their systems to ensure vaccinations on specified dates. The shipping company also recognised a weakness in their system and designed a new template for agents to use detailed exact export dates.
CASE 2: CASTRATION DEATH SECONDARY TO EVISCERATION
A seven-month-old pony colt was castrated under general anaesthetic. The risks of complications, including evisceration, were clearly explained by our insured before beginning the procedure. The surgery appeared to go well, but bowel came out the castration wound immediately after.
Our vet contacted a referral facility for advice and attempted to suture the wound. This was unsuccessful so the area was protected with a bandage and the horse was sent on for surgery. Unfortunately, the pony failed to recover. The specialised treatment came to around $4,000 and there was concern about who should pay for this.
Our insured vet did everything right in presenting pre-surgical risk to the client and in carrying out the castration. It is well recognised that around 0.4% of castrations may eviscerate.
There was no breach of professional duty on the part of our vet. The practice excess with VPIS was $2,000 plus GST. In this case, it was felt it would be better to direct this money to the client to help pay the bill. This resulted in a successful resolution with all parties satisfied.
• Lessons learnt: Good proactive communication regarding possible complications is important and certainly shielded our insured from any possible blame in this case. While there was no breach of professional duty here, a common sense and practical approach to handling the case resulted in satisfaction for all parties.
A trainer wanted a liquid oral drench to stomach tube four horses. No registered equine liquid drench is available, so Matrix (abamectin/levamisole/oxfendazole) was prescribed. It is important to note that Matrix is available in two strengths: Matrix mini dose for sheep and Matrix C, which is four times the strength. The horses’ owner was given Matrix C.
The vet assumed that the mini dose had been dispensed and gave instructions for a dose rate based on that product when the dose recommended was in fact four times that. One of the horses developed acute nervous signs, collapsed, and eventually died.
By failing to establish the strength of the drench dispensed, our insured had breached his professional duty and was liable. After negotiation a realistic value of the horse was obtained, and the owner was compensated for the loss.
• Lessons learnt: Matrix contains levamisole which has a very narrow margin of safety in a horse. Toxicity is, effectively, organophosphate poisoning. Take extreme care when prescribing “off label” products, especially if they contain levamisole.
CASE 4: DEATH OF A HORSE AFTER TUBING
A valuable sport horse was treated for colic. As part of that treatment, it was stomach tubed with liquid paraffin. There was an issue with the tubing process. The horse developed respiratory signs and was sent to a referral clinic. A transtracheal wash revealed paraffin in the lungs and aspiration pneumonia.
After an initial response, the horse deteriorated and was euthanised. The condition was attributable to a failure on the part of our insured vet and a settlement was negotiated.
• Lessons learnt: With the advent of paste wormers, stomach tubing is a procedure that is performed less often than it used to be. Technique is important, and care needs to be taken to establish the positioning of the stomach tube with absolute certainty.
CASE 5: POSSIBLE SE TOXICITY
A horse underwent a veterinary examination for poor impulsion and stiffness. Routine bloods were taken, and a low blood selenium was noted. Sup‐plementation was advised. A communication mixup ensued, and the horse was double dosed with selenium over a period of two weeks at which time the error was recognised. A blood re-test at this time showed no toxicity. The horse subsequently went to a referral clinic for work up for another issue and the selenium was rechecked. The result was again normal.
Six months later, the practice was contacted by the owner, who believed the horse’s performance had been compromised by a condition she perceived as being linked to selenium toxicity. An expert opinion was sought, and the horse was re-examined. No clinical signs relating to selenium toxicity could be found.
There was no breach of professional duty, this was communicated to the owner, and liability was denied.
• Lessons learnt: Take care of dose rates. Beware clients with some self-gained veterinary knowledge!
Keep good records when communicating with clients, particularly with someone who appears potentially
‘problematic’.
CASE 6: DEATH OF A HORSE WITH A NERVOUS DISEASE
A pony in an isolated region developed acute nervous signs including stiffness and ataxia. The only vet on duty was a small animal vet covering all calls. The vet contacted a more experienced colleague before and after seeing the pony. The vet made a tentative diagnosis of ryegrass staggers but, for safety’s sake, sent the pony on to a referral facility.
Upon arrival, with the aid of blood tests, the pony was diagnosed with the unusual condition, hyperammonaemia. The syndrome was severe enough that the pony did not survive.
The owner felt the vet attending lacked experience and made the wrong diagnosis. They sought the value of the pony and treatment expenses.
Our insured did absolutely nothing wrong. An experienced colleague was consulted throughout, and the original diagnosis was rational and appropriate, as was the decision pathway. After consultation with the insured practice, we took a pragmatic approach to this case. The practice had an excess of $2,000 for any claim and while we could have defended it, this would have cost more than the excess and created ill will with the client and distress for the vet. The referral treatment expenses amounted to $1,500 and we felt that the practice paying this bill directly was better than spending the money on insurance excesses.
This pathway was taken after carefully explaining to the client that the vet had done nothing wrong but there are no winners in a situation like this and the practice felt money was better spent helping the client through their unfortunate circumstances rather than on defending a claim. The result was that all parties were satisfied.
• Lessons learnt: Good communication, decision making, and support go a long way to mitigating risk, even when experience is less than optimal. Professional indemnity insurance is about resolving a claim and not necessarily about proving who is right or wrong, this resolution may not always appear “fair”.
CASE 7: DRUG RACE WITHHOLDING TIME MISTAKE.
A vet had prescribed the antihistamine cetirizine for a respiratory condition. The NZEVA guide to withholding times was checked and the drug was not listed. The vet incorrectly assumed that this meant there was no withholding time and the standard “one clear day” applied. However, the list put out by the NZEVA is a not a comprehensive list of all drugs used in horses, it is a guide that includes only drugs commonly used. The trainer of the horse was subject to a regulatory hearing, found guilty of presenting a horse for racing that contained a prohibited substance and a fine was imposed. The drug had been used on veterinary advice; therefore, our insured vet was liable and VPIS reimbursed the trainer for the fine that had been paid.
• Lessons learnt: The NZEVA prohibited substance recommended withholding times is not a comprehensive list. If a drug does not appear on it, especially if it is a drug not commonly used, make enquiries, and assume it has a withholding time until proven otherwise.
COMMENTS ON THESE CASES
There is a common denominator in most insurance claims. Very few arise from true clinical mistakes, most revolve around poor communication. This may be internal through poor implementation of practice systems, or it may be through ineffective interaction with clients. Poor communication, record keeping, and internal processes also feature in Veterinary Council complaints. There is no doubt that attention to this important part of veterinary practice will reduce claims. The cases described here also show that timely and clear communication can have a positive influence by minimising exposure in the event of client conflict.
It is important to remember that, as insurers, we are only involved when things go wrong, and it is far more likely that potential client conflicts will have already been resolved as result of good communication. As a profession trusted by the public, veterinarians are highly regarded and much of this is because of our communication skill; we do it well so let us continue to do just that.
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