GA death, violent owner, post mortem?

Re: GA death, violent owner, post mortem?

Martin Atkinson — Thu, 11 Jun 2015 17:18:41 GMT

[quote user="grumpyoldman"]He dumped it and signed it over , We did what we could and it survived and recovered over a few weeks .[/quote]Well youdid more than I would have done old man, I would have euthanased it. Trouble is with gypsies signing forms is that that most can't read or write so you need to make sure you have a witness to the verbal exchange.

[quote user="grumpyoldman"]Interestingly if you go into some of their homes ,as well as not being particularly nice there are often holes punched in lots of the doors .[/quote]Surprising Their caravans are usually immaculate with, admittedly rather distasteful, expensive fittings and crystal windows.

Re: GA death, violent owner, post mortem?

grumpyoldman — Thu, 11 Jun 2015 16:23:21 GMT

Some clients are really unstable , I had one pikey last year , OOH sunday afternoon consult ,no money swollen ruptured emphsematus uterus ,pyo ,toxic shock presented in a carrier bag. He dumped it and signed it over , We did what we could and it survived and recovered over a few weeks . Then the nurses rehomed it .Did not think anymore about it until a month later when he came storming into the practice demanding his dog . I explained that it had recovered and been rehomed. He started running up and down in the waiting room kicking furniture and smashing into plaster board walls . The terrified nurse hid behind the reception door clutching a shovel. I told her to call the Police ,Variety of threats business and personal. Terrible halitosis and B.O. when he squared up to me, these people never seem to invest in soap either ?Police escorted him away , quite well a well known local undesirable by all accounts. Interestingly if you go into some of their homes ,as well as not being particularly nice there are often holes punched in lots of the doors . They will probably do the same things at home if their football team looses .

Ask the VDS to deal with it offer free cremation with ashes if they allow an expensed paid PME , Then take a few days off and get away from it.

Re: GA death, violent owner, post mortem?

Anthony Todd — Thu, 11 Jun 2015 13:41:53 GMT

[quote user="Francisco Gomez"]We can talk about post-mortem results all you want, but I think it belongs to another thread.[/quote]

Sorry, I thought what I said initially expressed sympathy, if I didn't I do now completely.

However, as happens so often in tragic circumstances, if something can be learned from it grievers always express the wish that it will help others, which is why I responded.

Arlo, if you or anyone is unhappy with what I have posted on this thread please delete it.

I've started another thread which, I agree, may have been a better route.

Re: GA death, violent owner, post mortem?

Francisco Gomez — Thu, 11 Jun 2015 13:22:11 GMT

[quote user="Anthony Todd"]

And this might help "82% of preventable deaths due to human error"

[/quote]

I'm sorry Anthony, but help who? The main problem of the OP story is that a criminal guy made a hole through the consultation room and should be prosecuted, while the abused person, an employee vet, had been shaken to the point of wanting to take up the self-destructive habit of smoking.

We can talk about post-mortem results all you want, but I think it belongs to another thread.

Re: GA death, violent owner, post mortem?

Anthony Todd — Thu, 11 Jun 2015 13:17:34 GMT

And this might help "82% of preventable deaths due to human error"

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743650/

Re: GA death, violent owner, post mortem?

Anthony Todd — Thu, 11 Jun 2015 13:11:56 GMT

[quote user="Hannah Wynne Richards"]offering a free independent post-mortem [/quote]

Trouble is that very rarely does the PM give a report that blames the animal, or points to the animal being involved in any way.

So if it wasn't the animal it must be the vet....

Re: GA death, violent owner, post mortem?

Anthony Todd — Thu, 11 Jun 2015 13:01:14 GMT

[quote user="Martin Atkinson"]I would be surprised if the OP hadn't got all these things covered. [/quote]

Well the things I listed I have either seen or heard even though everyone concerned had "gone over everything" including the things I mentioned.

If I told you that an experienced vet thought that, to check sodalime you either, just looked at the colour on the outside of those clear canisters or through the top in the metal ones you might agree with me.

I have seen unexpected deaths in apparently healthy animals even after all I mentioned had been eliminated but most of the deaths we looked at together had one or other of the factors I listed possibly involved, and I can't see the harm in just going over the factors which may have been involved and eliminating them so they never happen again.

One thing I have just remembered is to induce with a more than adequate dose of whatever then put the animal straight on a high flow of iso or whatever and bag the animal that hasn't breathed.

And I'm worried about the cardiac monitoring now emphasised because when the heart stops that's it whereas almost always the respiration has stopped minutes before but nobody has noticed because of this fixation on cardiac monitors.

If one vet picks up one caveat, which hopefully we'll all contribute to, then I'll be happy ,but this idea that every anaesthetic death can't be predicted or prevented won't prevent the avoidable deaths because nobody will think they occur.

Re: GA death, violent owner, post mortem?

J G Wray — Thu, 11 Jun 2015 12:36:29 GMT

[quote user="Evelyn Barbour-Hill"]Yes,the boss (not you, unless you are the senior partner) should call the owners, speak at length to them, maybe arrange a meeting. Not the practice manager! How would you feel if this happened to you and you were just invited to talk to some office functionary? You'd want to talk to a vet! The senior partner should be talking to them (after taliking to you). This is what senior partners are for.[/quote]

Quite.

Re: GA death, violent owner, post mortem?

Martin Atkinson — Thu, 11 Jun 2015 12:32:21 GMT

[quote user="Anthony Todd"]Sorry if it's all obvious to all of you but I was always surprised by the obvious things we discovered after the event.[/quote]Anthony I would be surprised if the OP hadn't got all these things covered. IME and according to cardiologist Mark Patteson on Snowscene, the majority of unexplained sudden deaths in dogs under anaesthetic are due to unsuspected cardiomyopathy leading to a fatal arrhythmia and/or cardiac arrest. Without constant ECG monitoring this is something that may not get picked up and even then it may be too late. Mark did suggest that because of this we should not use Alpha-2 agonists as part of the anaesthetic protocol in dogs. However we know that in general practice the advantage of these outweighs the risk in the majority of cases so its still not wrong.

Re: GA death, violent owner, post mortem?

Anthony Todd — Thu, 11 Jun 2015 12:11:27 GMT

Deleted as requested and reposted as separate thread.

Re: GA death, violent owner, post mortem?

Glen McIntosh — Thu, 11 Jun 2015 11:49:23 GMT

[quote user="Martin Atkinson"]What struck me me though, which I can't see has been touched on since, is what became of the police involvement? The only party wronged here is you. The client should be charged with assault and criminal damage.[/quote]

Yes, I agree. While of course I understand and sympathise completely with clients in this situation, there is a limit, and the behaviour described in the OP is criminal and unacceptable under any circumstances and cannot stand.

One of my colleagues where I currently work was physically assaulted after a dog he had seen in the morning had died a few hours later. The client came back to the clinic in the afternoon, barged into the consulting room and slapped my colleague across the face. The police were called but my colleague declined to lay charges.

I told him that I really believed that it was the wrong decision not to press charges, even if he felt in some way guilty about the situation (which is natural, but he really shouldn't).

When clients display this type of behaviour, I don't care what the circumstances are that led to their behaviour, the behaviour is unacceptable under any circumstances.

Re: GA death, violent owner, post mortem?

Hannah Wynne Richards — Thu, 11 Jun 2015 11:45:55 GMT

OK but a 3rd party - not the veterinary surgeon involved.

Wynne

Re: GA death, violent owner, post mortem?

Evelyn Barbour-Hill — Thu, 11 Jun 2015 10:31:18 GMT

[quote user="Hannah Wynne Richards"]Ask VDS, but a phone call from the practice manager(not youself)[/quote]

Oh Wynne, not the practice manager.

Re: GA death, violent owner, post mortem?

Martin Atkinson — Thu, 11 Jun 2015 09:53:56 GMT

First thing, its easy to say but not so easy for you, but don't worry you did nothing wrong, these things happen, they have happened to all of us and will happen again. So try and put the clinical issue behind you after you have assessed what you did and learn how you could do it differently in the future, which I suspect is very little. The VDS will support you and it will pass over to be just another life experience.

People like this rarely come back again once the red mist has cleared. But in some ways you should consider yourself lucky it was a client - one of my nurse's boyfriend assaulted me and threatened me and my family with a fate worse than death just because he thought I had slighted her!

What struck me me though, which I can't see has been touched on since, is what became of the police involvement? The only party wronged here is you. The client should be charged with assault and criminal damage.

I wouldn't contact the client again at this stage I would wait for them to make next contact. And keep the body as long as is practical but only perform a PM examination, bearing in mind that result will compromised now it has been frozen, if the client requests it but advise them they will be responsible for charges. If there is no contact after a while you may then contact them and advise them that you will have to dispose of the body for health and safety reasons, say within 2 weeks, if they don't express an alternate wish for its disposal.

Don't lose sight of the fact that they still owe you for everything you did, they presumably signed a consent form to advise them of the risk of anaesthetic. Whether you wish to enforce this is another matter but make sure if you don't that they realise that you are waiving fees purely as a gesture of goodwill not as acceptance of any fault.

Re: GA death, violent owner, post mortem?

Hannah Wynne Richards — Thu, 11 Jun 2015 08:42:05 GMT

Firstly. This doesn't mean that you're a bad veterinary surgeon. A bad veterinary surgeon simply wouldn't care that the dog had died.

Secondly. These may be violent people - in which case you have reason to worry. They may also be "normal" people who just "lost it" due to being terribly upset, and who are now thoroughly ashamed of themselves.

Ask VDS, but a phone call from the practice manager(not youself) offering a free independent post-mortem may be helpful. Also a letter from yourself, not mentioning the violence, or accepting blame, just sympathising with them on the death of an obviously well-loved member of the family.

Wynne

Re: GA death, violent owner, post mortem?

Jo Dyer — Thu, 11 Jun 2015 08:25:21 GMT

What an awful thing to happen to you, that is a nightmare scenario. We've probably all had the unexpected anaesthetic death, which is quite bad enough, but to have the owners displace all their grief onto you as well..........you poor thing. As well as calling VDS, who are always incredibly helpful and supportive, please phone Vet Helpline (0303 040 2551) as well. They are not just there for suicidal people. You need and deserve proper support.

Re: GA death, violent owner, post mortem?

Kate Richardson — Thu, 11 Jun 2015 07:51:34 GMT

See if you can cancel a couple of routine appointments to give yourself time. Your receptionists sound as though they would be supportive of this and I would hope your bosses would understand.

Re: GA death, violent owner, post mortem?

An On MRCVS — Thu, 11 Jun 2015 07:13:51 GMT

Thank you so much everyone. Apologies about lack of paragraphs, using ipad, and it seems to make them disappear! I am an employee, the only employee, two practice partners. One of the two partners was away yesterday, and I was doing his ops list.... The receptionist joked I coped better with the owners when they got nasty than he would have! (I think this was just to make me feel better, along with very sugary tea!) I am a VDS member, and will phone them this morning as soon as I get into work. It's just frustrating to find the time. Consults all day, fully booked (I do get breaks, but I have hospitalized patients to reassess, lab results to analyze etc). Anyway, there are not enough minutes in the day no matter what the problem. I think Nottingham is our nearest vet school, so I will call them about an independent PM. I logged everything that happened on our system yesterday. The anaesthetic recording sheet is a bit, I don't know, empty, because of course what happened was, nurse took first 5 min measurement when all was fine, then after that the dog deteriorated pretty rapidly, all hands were on deck, everyone was doing something, obviously no-one was recording what was happening as it was happening, because we were all trying to save the dog. But of course we live in an era where if you didnt write it down, it didnt happen! I did hand write everything on the back of the GA sheet after, and then transcribed it onto the electronic notes. Like I don't know at what exact minute everything happened, but I wrote everything down, what change led to what action, and got two nurses who were the two present with me from beginning to end to review and confirm all the details. Again I can't emphasize enough how much you have all helped. I posted last night as I was lying in bed unable to sleep because it was running through my mind. Your replies helped me sleep, and that is a great gift. Thank you.

Re: GA death, violent owner, post mortem?

Evelyn Barbour-Hill — Thu, 11 Jun 2015 00:49:50 GMT

There can't be many vets more than 10 years out who haven't had an unexpected anaesthetic death.

Ghastly for you to have to suffer the owners' reaction, but.... it's something you do have to do. Not suffer actual violence of course, but stand there feeling lousy witnessing the tears and the bitter words.

Some people just have to lash out when some catastrophe befalls them – take it out on a door, for instance – I feel they are really lashing out at fate.

What next? Firstly, phone VDS first thing in the morning and don't do anything until you've done that. You'll find the adviser sympathetic and not judgmental – they've all seen this many times before. Follower their advice very closely.

Post mortem seems a good idea; you could start by asking your own regular laboratory. BUT: you aren't allowed to do this, or to do anything else with the body, without the owner's permission. (There's probably some time after which you can do what you like if you've heard nothing, but I've no idea what it is). So to that extent, the practice has got to speak to the owners tomorrow anyway. They might not want a PM, they might want to take the body home or something else, they might want to take it for a PM themselves.

Yes,the boss (not you, unless you are the senior partner) should call the owners, speak at length to them, maybe arrange a meeting. Not the practice manager! How would you feel if this happened to you and you were just invited to talk to some office functionary? You'd want to talk to a vet! The senior partner should be talking to them (after taliking to you). This is what senior partners are for.

(Unless you are in one of those unhappy practices where the senior partner will try to buy the owners off, or blame it all on to you. I hope not)

Re: GA death, violent owner, post mortem?

Michael Woodhouse — Wed, 10 Jun 2015 23:50:28 GMT

Anaesthetic deaths are a rare but inevitable event (I've had 1, know of another whilst I was in practice with another vet operating). Sounds like you did absolutely everything right.

You don't say, but I assume you are an employee? Where is your boss? They should be dealing with this shit.

Re: GA death, violent owner, post mortem?

Rory Bell — Wed, 10 Jun 2015 23:45:38 GMT

I'm sorry this has happened to you Anon, my sympathies.

My thoughts (which largely summarise what others have said):

1) Contemporaneous notes are key, so if you have not done so already, write everything down on whatever filing system (electronic or otherwise) you have. Make sure there are notes from the resuscitation procedure to depict that you did everything that you could

2) Tomorrow morning, get everyone who was observing through the window to do the same (write down what they saw and did), including whoever called the police. If the police were called, they will have logged an incident number. Get that too. Get a photo of the hole that was punched; make sure it's timed and dated.

3) If you are not the practice principal, tell them what's happened.

4) Call the VDS (assuming you are a member). Send them your case notes, plus everything from points (1) and (2) above.

5) PM's, like Andy said, loads of uni's will do them for little money. We use Nottingham, but, again like Andy said, investigations into sudden anaesthetic deaths are often unrewarding.

6) If you are not on call (and I hope you are not) then go and do something that will help distract and relax you (go for a run or watch a cool film possibly with a glass of your favourite tipple, or a hot chocolate). Don't do anything cerebral (like reading) because that won't work. You need to be proactive in helping to make sure that this does not overwhelm you. You did nothing to bring this on yourself, so make sure you come out of this unscathed.

Above all else, good luck and PM me if I can help

Re: GA death, violent owner, post mortem?

Andrew Kent — Wed, 10 Jun 2015 23:03:00 GMT

Hi Anon,

these are really tough situations, I am sure you did everything you could and it is just one of those unfortunate things so don't be too hard on yourself.

where about a in the country are you? I know that we (and many other university pathology departments) offer full post mortems and are not very expensive. Nottingham do the same and I am sure others. So a call to your nearest vet school is likely to be the best option. Ideally the dog should be chilled but not frozen (may be too late for this).

sadly the majority of these cases a definitive cause is not found

keep your chin up :-)

Andy

Re: GA death, violent owner, post mortem?

karen jones — Wed, 10 Jun 2015 23:01:51 GMT

We had pm of sudden death in gsd done by university of Liverpool this spring so worth speaking to them depending where you are. Again ask vds for help and document everything you did and said and get the nurses to do the same .

Re: GA death, violent owner, post mortem?

Kate Richardson — Wed, 10 Jun 2015 22:56:46 GMT

Poor poor poor you and all your staff. What a horrible shit thing to happen. You did nothing wrong and all you could but sometimes shit happens with no explanation. I hope it was just shock, doesn't excuse it, but maybe once they calm down they will apologise. I would write a letter explaining you did all you could and how absolutely awful you feel. You might not even send it but you will probably feel better for writing it. No harm in contacting the vds but if you have a signed consent form then you should have nothing to worry about from that point. But they are always good to talk to and will likely reassure you that you did nothing wrong and shit happens and is no ones fault. Sadly incidents like this are a reminder that there is a risk, but keep it in perspective, think of all the successful ga's you have performed. Really hope you feel better soon and talk about if you need to, to us or a professional or a colleague.

Re: GA death, violent owner, post mortem?

Yantha Smyth — Wed, 10 Jun 2015 22:48:18 GMT

Wow, what an awful thing to happen. I feel for you. +1 to speak to VDS and write down everything-yourself and your colleagues, ensure clinical notes thorough and accurate. I think there is a place in Surrey that carries out independent post-mortems. Not sure if it is the University of Surrey or someone else. Perhaps the local veterinary school would do it or point you in the right direction?

I think it would be worthwhile a phone call from the PM or yourself if you feel up to it, saying how devastated the staff are and that after reviewing the procedure etc no explanation has been forthcoming, and... offer an independent PM in order to try to shed light on what happened...

Things like this happen so rarely that it is a real shock to all involved. Despite us knowing there is always a risk etc, so many anaesthetics go well even in the high risk patients. Its a wonder it doesn't happen more often really.

It sounds like you did everything you could, so also don't be too hard on yourself.