Would you stop in the middle of surgery if owner changed their mind??

Re: Would you stop in the middle of surgery if owner changed their mind??

Hannah Wynne Richards — Fri, 08 May 2015 07:14:28 GMT

An On Great news

Wynne

Re: Would you stop in the middle of surgery if owner changed their mind??

Francisco Gomez — Thu, 07 May 2015 21:43:39 GMT

What did VDS say?!?

Re: Would you stop in the middle of surgery if owner changed their mind??

An On MRCVS — Thu, 07 May 2015 21:08:32 GMT

Hi All. An update:

The owner has informed the practice that they are happy now with the outcome (fully recovered dog) and have signed a payment plan.

I dont fully trust them, having changed their minds before, but it looks at present like nothing will come of their threats of a complaint to RCVS.

This experience really did shake me and make me reflect on how to prevent thus happening ever again. But thank you all so much!!

Re: Would you stop in the middle of surgery if owner changed their mind??

Mark Hedberg — Wed, 06 May 2015 08:48:48 GMT

[quote user="Evelyn Barbour-Hill"]

The only bone of contention

[/quote]

No pun intended, i'm sure :)

Re: Would you stop in the middle of surgery if owner changed their mind??

rjhvet — Tue, 05 May 2015 23:06:09 GMT

I am in agreement with this post.

Re: Would you stop in the middle of surgery if owner changed their mind??

Evelyn Barbour-Hill — Tue, 05 May 2015 23:01:12 GMT

I'm not a lawyer but... ()...

You may find that you can't compel the owner to pay for the surgery, because you were doing it without permission. Still, I suspect you are going to have trouble getting any payment at all.

I think probably you committed a surgical trespass. However, the owner can't claim any damages because the end result was an inprovement!

The owner's other contentions are nonsense. Everything you did was fine. The only bone of contention is that you continued the surgery after the owner withdrew permission.

I hope you've already spoken to VDS. I doubt if he will, in the event , enter a complaint about you but it would be wise to make a written record of everything, with witnesses if possible, while it's fresh in your mind.

Re: Would you stop in the middle of surgery if owner changed their mind??

An On MRCVS — Tue, 05 May 2015 22:02:06 GMT

Hello and thank you all for your comments.

Yes had started the insision of skin. But that is not the crux for me. Rather that the radiopaque objects had sig more gas dilatation proximally, that they had not moved and diff to see location. Was concerned re perforation/ peritonitis. And that this was a sicker vomiting more painful dog. And that O had fully given permission and that I had no knowledge of any issues with the O previously.

The crux for me was that a very sick dog was already under GA.

A bizarre thing to liken surgery in an attempt to cure a sick animal to rape.....

Re: Would you stop in the middle of surgery if owner changed their mind??

Hannah Wynne Richards — Tue, 05 May 2015 17:29:54 GMT

Francisco

Thanks

Wynne

Re: Would you stop in the middle of surgery if owner changed their mind??

Martin Atkinson — Tue, 05 May 2015 16:57:49 GMT

[quote user="Francisco Gomez"]I'd think stopping the anaesthetic knowing that you need another one is an unnecessary risk that you're putting the patient through.[/quote]Reasonable point I was assuming the client wanted surgery aborted full stop therefore no additional anaesthetic required.

Re: Would you stop in the middle of surgery if owner changed their mind??

Francisco Gomez — Tue, 05 May 2015 16:48:17 GMT

[quote user="Martin Atkinson"]

I really can't see how aborting the anaesthetic and letting the animal recover is any more risk, indeed is almost certainly less, than continuing. Whether the animal then requires other treatment/fluid while it recovers is not an issue. The crux is not the anaesthetic but how far surgery had progressed.

[/quote]

I disagree here. I'd think stopping the anaesthetic knowing that you need another one is an unnecessary risk that you're putting the patient through. I'm sure I'm not the only one who'd seen a patient die from a GA induction for a procedure where you were hoping to save its life.

IMO the crux is if the anaesthetic had been administered or not in an non-routine procedure.

Re: Would you stop in the middle of surgery if owner changed their mind??

Martin Atkinson — Tue, 05 May 2015 16:26:02 GMT

[quote user="Hannah Wynne Richards"]

Once the anaesthetic had ben given, then the adverse cosequences of waking up, followed by a rapid re-anaesthesia to an animal which was highly likely to be already toxic, would more than warrant prosecution - and (hopefully) an exemplary custodial sentance.

Wynne

[/quote]Whilst I'm broadly in sympathy with the indignation you express Wynne I do feel you are being more than a little over emotive. I really can't see how aborting the anaesthetic and letting the animal recover is any more risk, indeed is almost certainly less, than continuing. Whether the animal then requires other treatment/fluid while it recovers is not an issue. The crux is not the anaesthetic but how far surgery had progressed.

Re: Would you stop in the middle of surgery if owner changed their mind??

Bob Russell — Tue, 05 May 2015 15:51:36 GMT

[quote user="Michael Woodhouse"]

[quote user="Martin Atkinson"]I think this post is totally out of order Michael, not only is it unnecessary, offensive and aggressive - the last thing the OP wants under the circumstances, IMO you are wrong.[/quote]

The owner can remove consent at any time. Just because we have the dog in the kennel, just because it has had a premed, just because you've clipped it, cleaned it and picked up your scalpel, doesn't mean they can't change their mind. Obviously if you are half way through the operation and you have two ends of gun in your clamps then there is no option to carry on.

We've had a nutty client ring up and change their mind in very similar circumstances (for a routine spay of all things) - the dog was anaesthetised and clipped and even draped.

There is no way I would have continued with a surgery that I had only just started (as suggested by the OP) if the owner rang and withdrew consent. Consent is a dynamic thing that can be withdrawn at any time.

I'd want to know what their plans were with the dog (other practice etc).

[/quote]

For a routine elective procedure I would be willing to consider stopping at any point up to the first incision. This was a sick dog and waiting for full recovery before releasing to the owner does not appear to be an option. I would not release a patient to the owner until I was satisfied it was not at risk from the anaesthesia.

One case where I would happily be on the phone to the RSPCA (note the double standards here)!

Re: Would you stop in the middle of surgery if owner changed their mind??

Hannah Wynne Richards — Tue, 05 May 2015 15:43:56 GMT

Wynne

Re: Would you stop in the middle of surgery if owner changed their mind??

Michael Woodhouse — Tue, 05 May 2015 12:58:35 GMT

[quote user="Martin Atkinson"]I think the line was crossed once the OP had entered the abdomen. The impression I got from anon was that she had already begun surgery.[/quote]

The OP says:

[quote user="An On MRCVS"]Started surgery, but just as incising,[/quote]

Sounds like the very beginning of the surgery, rather than rooting about in the abdomen.

Re: Would you stop in the middle of surgery if owner changed their mind??

Hannah Wynne Richards — Tue, 05 May 2015 12:10:31 GMT

Micheal. They have zero legal right to cause unnecessary suffering. If things have progressed to the point where aborting and allowing the animal to wake up could cause unnecessary suffering, then the only options left to the owner which don't carry the possibility of imprisonment are continue or kill.

Wynne

Re: Would you stop in the middle of surgery if owner changed their mind??

Anne Seawright — Tue, 05 May 2015 11:25:14 GMT

[quote user="Martin Atkinson"]

[quote user="Anne Seawright"]he returned following me into the dispensary area and pining me against the wall threatening me. Luckily his wife got him off me and out of the building but I have wondered what happened to the dog. Vds were very supportive so I definitely suggest contacting them ASAP.[/quote]What a big brave man!! I wonder what his wife saw in him to stay with him. I hope you reported this incident to the police.

[/quote] I think she must sadly be used to his behaviour. Yes it has been reported and he has been charged so just waiting for next stage.

Re: Would you stop in the middle of surgery if owner changed their mind??

Martin Atkinson — Tue, 05 May 2015 11:18:28 GMT

Re: Would you stop in the middle of surgery if owner changed their mind??

Martin Atkinson — Tue, 05 May 2015 11:14:31 GMT

[quote user="Michael Woodhouse"]The owner can remove consent at any time. Just because we have the dog in the kennel, just because it has had a premed, just because you've clipped it, cleaned it and picked up your scalpel, doesn't mean they can't change their mind. Obviously if you are half way through the operation and you have two ends of gun in your clamps then there is no option to carry on.[/quote]I think the line was crossed once the OP had entered the abdomen. The impression I got from anon was that she had already begun surgery.

Re: Would you stop in the middle of surgery if owner changed their mind??

Anne Seawright — Tue, 05 May 2015 11:07:13 GMT

Anon do you know if this dog was seen at another practice prior to ending up with you? The reason I ask is while locuming a few weeks ago I saw a similar case where a FB was suspected and the owner became very aggressive. The dog was anorexic, had been vomiting for 3 days and hadn't passed faeces. It's abdo was tense. A FB was suspected and an estimate given for exlap +\- rads/bloods etc and this was explained fully in the stages we could proceed to try to save money. The male owner became very aggressive and left the building kicking doors on the way out. Unfortunately his wife (who was lovely and wanted to do the best by the dog) refused to leave so he returned following me into the dispensary area and pining me against the wall threatening me. Luckily his wife got him off me and out of the building but I have wondered what happened to the dog. Vds were very supportive so I definitely suggest contacting them ASAP.

Re: Would you stop in the middle of surgery if owner changed their mind??

Michael Woodhouse — Tue, 05 May 2015 10:56:00 GMT

We've had a nutty client ring up and change their mind in very similar circumstances (for a routine spay of all things) - the dog was anaesthetised and clipped and even draped.

I'd want to know what their plans were with the dog (other practice etc).

Re: Would you stop in the middle of surgery if owner changed their mind??

Hannah Wynne Richards — Tue, 05 May 2015 10:24:26 GMT

Or for that matter for inciting another to break the law - which may result in a longer term of imprisonment.

Wynne

Re: Would you stop in the middle of surgery if owner changed their mind??

Hannah Wynne Richards — Tue, 05 May 2015 10:17:27 GMT

If these owners complained, I would hope Royal College would have the robustness to state unequivocally that if An On had acceeded to their request, both he/she and them would be liable under the Animal Welfare Act for 51 weeks imprisonment and a £20k fine. I would also hope that Royal College would remember that it is a criminal offence to incite another to break the law - and contact the police - so these people could be dealt with by the magistrates.

At the moment it's An Ons word against theirs, but if they're sued for the bill, and then give evidence in the Small Claims Court, then they will have admitted their criminal guilt in front of an uninterested 3rd party, so their prosecution under the AWA will be far simpler.

Wynne

Re: Would you stop in the middle of surgery if owner changed their mind??

Martin Atkinson — Tue, 05 May 2015 10:08:50 GMT

[quote user="Michael Woodhouse"]

Lets say you are in bed with your partner. You are having a kiss and a cuddle. You each take off your clothes and then your partner says they don't want to have sex. Is it OK to carry on because you've started?

Of course it bloody isn't.

An owner can withdraw consent at any time. You shouldn't have done the surgery.

[/quote]I think this post is totally out of order Michael, not only is it unnecessary, offensive and aggressive - the last thing the OP wants under the circumstances, IMO you are wrong.

Anon you acted exactly as I would have done. The welfare of the patient would have been compromised if surgery was aborted mid-procedure I would have continued. The RCVS will have no issues with this you acted reasonably at every stage of the procedure. You are perfectly entitled to pursue the bill through the appropriate channels. However I would like the security of the VDS behind me so I would send all the details to them.

Above all don't worry about it and don't let it get to you. We've all had situations like this with unreasonable clients, sadly they are the ones we remember rather than the 99% of decent ones.

Re: Would you stop in the middle of surgery if owner changed their mind??

Bob Russell — Tue, 05 May 2015 09:47:18 GMT

Once anesthetised surgery has commenced IMO. I would accept a decision to euthanase the patient at any stage as an owner is fully entitled to demand this.

The surgeon is committed to continue with surgery or to call a halt. Recovery to be followed by further anaesthetic after being transported to another practice would be unacceptable on welfare grounds IMO. I would expect the RCVS and even the RSPCA to back me up on this one.

Why on earth are some people never satisfied even with a happy outcome?

Re: Would you stop in the middle of surgery if owner changed their mind??

J G Wray — Tue, 05 May 2015 08:46:51 GMT

[quote user="Francisco Gomez"]

[quote user="J G Wray"]

RCVS are not at all honest about publishing the number of complaints that are vex and friv, which is shameful.

[/quote]

Would you want them to publish the name of the vet who's receiving this complaints or the client who made it?

[/quote]

RCVS' honesty could begin with a statement and maintained in their annual review that there are a proportion of cases which are vex and friv. Just the numbers would do as a percentage of those which never even get to PIC. it's a small ask.