Reporting cruelty - advice please

Re: Reporting cruelty - advice please

Martin Jones — Thu, 16 Sep 2010 16:14:46 GMT

Well done, you. Time to follow it up with a letter giving him 7 days notice as a client, stating the reasons and that you've informed the RSPCA so that they can keep tabs on the situation?

Re: Reporting cruelty - advice please

plantagenet — Thu, 16 Sep 2010 16:08:36 GMT

Many thanks to all you who posted advice, it is really supportive to know other people have similar problems.

I wrote a factual, but hopefully uninflammatory letter, to the client outlining the injury, the possible treatment and the necessity for pain relief. When what I had dispensed must have run out I phoned. After a fairly heated conversation (on Mr X's part) during which I was accused of harrassment, I managed to get it across to him that failure to get treatment from a vet (not me in particular) would result in me reporting him. I gave him 24h during which I expected to have notes requested from another vet - and so it was on the following day.

I kept very detailed notes, informed the RCVS and VDS at all stages and had a nurse listening while I phone the client.

I hope that's the end of it and the poor dog gets what it needs, but it seems out of my hands now.

Re: Reporting cruelty - advice please

Kate Richardson — Tue, 07 Sep 2010 13:51:26 GMT

Shame Rob left before reading Malcolm's post. He was certainly a vociferous minority on this forum in this thread and others. Am sure we could have converted him eventually

Re: Reporting cruelty - advice please

Edward Jones — Mon, 06 Sep 2010 20:57:39 GMT

At least he didn't take the ball home with him as well.

Re: Reporting cruelty - advice please

Martin Jones — Mon, 06 Sep 2010 20:32:30 GMT

I'd just love to know what constitutes an automatic sending off. Death threats? Not even RMB has elicited that one yet......

Re: Reporting cruelty - advice please

Bob Russell — Mon, 06 Sep 2010 17:32:55 GMT

Do we lose points for a yellow card?

Re: Reporting cruelty - advice please

Hannah Wynne Richards — Mon, 06 Sep 2010 16:48:51 GMT

I wonder how Rob would cope with the PRACTICALITY of giving opioids to animals whose owners obviously won't pay for hospitalisation, and equally obviously are not long-standing regular clients whose good character is known to the practice. I think handing out opioids to all and sundry to administer would attract some very adverse attention from the local drug squad !!!!!!!!!!!!!!

To get back to the point Plantaganet. You obviously have a horrible problem

There was a time when we regarded client confidentiality as paramount, unless notifiable disease was involved or the veterinary surgeon had reasonable grounds to suspect that a crime was being committed, or was about to be committed, when it was acceptable to report to the proper authority. In 1987 Royal College produced one of the most infamous rulings in it's entire history. We were informed that we were banned from reporting organised dog-fighting, or badger baiting. It is that ruling that 1st made me doubt the "wisdom " of Council members, and I'm afraid I've remained a cynic ever since

That rule has thankfully now been canceled, and in 2003, after it was proven that people who deliberately harm animals, often went on to harm children, we were told that we should report cases of non-accidental injury. If you Plantaganet can honestly say you thought the owners had deliberately broken the dog's leg, then Royal College will support you. If not then I'm afraid they will carry on sitting on the fence. I wish they would give unqualified suport to any veterinary surgeon in your position

Having said that I can only endorse Andrew's position, and also thank Malcolm for constructive specialist advice

Good luck Plantaganet, and don't let Rob get you down

Wynne

Re: Reporting cruelty - advice please

Mark Holmes — Mon, 06 Sep 2010 14:08:13 GMT

[quote user="Arlo Guthrie"]it was meant to be a slightly tongue-in-cheek and unconfrontational way of saying 'order'[/quote]

You have a good sense of humour Arlo, it keeps things lightish hearted and fun. I hope I don't get yellow carded myself but is it were to happen I would not take it any other way.

Re: Reporting cruelty - advice please

Arlo Guthrie — Mon, 06 Sep 2010 13:59:14 GMT

[quote user="Andrew Kent"]Love the yellow card Arlo[/quote]

Credit to Jonathan Wray for that idea. Actually, it was meant to be a slightly tongue-in-cheek and unconfrontational way of saying 'order', although it clearly wasn't seen that way this time!

Re: Reporting cruelty - advice please

Bob Russell — Mon, 06 Sep 2010 13:20:18 GMT

Thank you Malcolm for your sane input! When I read Rob's post I realised that my clinical skills were rock bottom especially diagnosing causes of lameness. (sarcastic smiley if we had one!!!)

Strains and sprains are not 'dustbin' diagnoses - dogs are born athletes and frequently strain and sprain!!!

Flare ups of DJD seem to be common - probably because dogs are athletes as above and often do not have the sense to stop (nor do their owners). My experience is that they tend not to be 10/10 but I have seen it.

I find some cruciate problems tricky to positively identify in the conscious (and sometimes unconscious) dog.

NSAI's are helpful in most lamenesses and can help determine if further investigation is required. If the pain is relieved with NSAI's then a fracture is less likely. They can be useful filters!!

Re: Reporting cruelty - advice please

Malcolm Ness — Mon, 06 Sep 2010 09:00:04 GMT

Just back from a long weekend sailing around the isles of Bute and Arran so I missed this thread. Looks like toys have already been thrown from pram, but for what it is worth, here is my take on things.

If a vet thinks there is a welfare issue, there are two duties - first, cover your own arse. Record your advice and discuss with VDS or RCVS (ie pass the buck!). Second is to report the case. The new welfare legislation is heavy on "duty of care" and that applies to vets as well - if you haven't reported a welfare issue, the client might subsequently claim ignorance ("He didn't seem to be in pain because he wasn't yelping") but that defence isn't available to a vet.

wrt the clinical specifics:

[quote user="Rob Smith"]A non-displaced tibial plateau/crest # is not going to be diagnosable clinically.[/quote].

A strong suspicion of these can be formed on clinical exam (though either would be very unusual in a patient of this age). Incidentally, I manage many of these conservatively relying on NSAIDs for pain control. Does that make me a bad person?

[quote user="Rob Smith"]Whatever the cause, likely to be rather painful if 10/10 lame[/quote]

Probably, but do all vets reach for the opiates if a post op fracture/cruciate/nail removal/stitch-up etc etc is lame???

[quote user="Rob Smith"]Cruciate - should be able to diagnose on clin exam[/quote]

Absolutely not. Anybody relying exclusively on the well known diagnostic tests for cruciates is going to be wrong quite often. One of my residents published in JSAP on this subject recently.

[quote user="Rob Smith"]Cellulitis - should get hints from clinical exam, eg pyrexia[/quote]

Often but certainly not always.

[quote user="Rob Smith"]Flare up of DJD - no, this does not cause a dog to go from 0/10 - 10/10 lame[/quote]

Yes it does.

[quote user="Rob Smith"]Strain/sprain - dustbin "diagnosis"[/quote]

Nonsense. Strain and sprain injuries are well documented in many species including dogs - possibly over-used and sometimes applied with scant evidence but they are real diagnoses

Re: Reporting cruelty - advice please

Fiona French — Sun, 05 Sep 2010 20:46:58 GMT

[quote user="Arlo Guthrie"]

[quote user="Andrew Kent"] [quote user="Rob Smith"]In fact, I'm fed up of this forum. I quit.[/quote] I think this would be a shame as you clearly have something to bring to the forum - just perhaps in a more tactful manner!

Andy[/quote]

I fear it's too late. Rob asked me to disable his account, so I have.

[/quote]

Well, at least I can post again without worrying about being called illiterate.............

Re: Reporting cruelty - advice please

Arlo Guthrie — Sun, 05 Sep 2010 17:54:46 GMT

Andy[/quote]

I fear it's too late. Rob asked me to disable his account, so I have.

Re: Reporting cruelty - advice please

vs0u — Sun, 05 Sep 2010 16:44:56 GMT

A dose of buprenorphine only lasts 4-6 hours anyway so not much use if the dog is waiting overnight for further treatment...arguably nsaids more appropriate in this case as they last up to 24 hours. Especially as the leg was already fractured for several days and was going to be kept cage rested for some weeks...one off shot of buprenorphine seems like a waste of money!

Sorry back on topic...I would contact RSPCA but they are not always that bothered about helping with these cases unless they can see a court case coming. Have you suggested to the client that they could give the dog up for rehoming?

Re: Reporting cruelty - advice please

Andrew Kent — Sun, 05 Sep 2010 15:33:58 GMT

[quote user="Rob Smith"]SInce clearly we have to treat everyone as if they are wrapped up in cotton wool, even if they have been in practice for twenty years, it's best I don't say any more on the topic. In fact, I'm fed up of this forum. I quit.[/quote]

The point here is that we have all been surprised by injuries once we have the benefit of x-rays and that at the time given it was unknown this was a fracture. Dogs can be 10/10 lame from a soft tissue injury with no fractures and respond well to NSAIDs. Once a fracture was identified then better analgesia was given - this is completely appropriate.

You hijacked a perfectly reasonable request for advice with a confidence busting criticism and there was no need for this. It doesn't encourage the open forum exchange that makes this site what it is.

There are ways of bringing these things up in a polite and courteous manner without putting people off posting.

[quote user="Rob Smith"]In fact, I'm fed up of this forum. I quit.[/quote]

I think this would be a shame as you clearly have something to bring to the forum - just perhaps in a more tactful manner!

Andy

Re: Reporting cruelty - advice please

Rob Smith — Sun, 05 Sep 2010 14:32:00 GMT

I will not apologise for being genuinely concerned for the welfare of a dog with a fracture that was only given NSAIDs. I was concerned how many other animals are given merely NSAID for such a painful situation and hoped my pointing the issue out would make the author consider better analgesia next time. SInce clearly we have to treat everyone as if they are wrapped up in cotton wool, even if they have been in practice for twenty years, it's best I don't say any more on the topic. In fact, I'm fed up of this forum. I quit.

Re: Reporting cruelty - advice please

Andrew Kent — Sun, 05 Sep 2010 11:38:47 GMT

Plantagenet,

This site was created exactly for people in your situation - to allow you the benefits of colleague discussion even in a one vet practice. The vast majority of us are friendly folk who wish to share our resources and experiences and not judge you or make you question your abilities.

Don't let the minority put you off starting threads - they are the exception not the rule and hopefully as you will see you will get far more support than criticism. You have said nothing that would make me question your abilities so don't be too hard on yourself.

It is only through developing an open environment where we all feel able to express our experiences and opinions without criticism that this site will continue to develop and grow - I hope others consider this before posting comments that belittle others.

Andy

Re: Reporting cruelty - advice please

plantagenet — Sun, 05 Sep 2010 11:25:27 GMT

Apologies for misdirecting my reply - home internet felled by a dead tree and it is easy to push the wrong buttons on a blackberry!

Thank you, Rob, for pointing out that my clinical skills and veterinary ability are poor - something I have suspected for a long time. But please remember that there are real people at the end of your sharp tongue and it has certainly put me off starting a thread again.

Thanks for your support, the rest of you.

Back to the topic, that is really good advice so far and good to know other people have been in the same circumstances - I am keeping copious notes and my nurses are also aware of what has happened.

It is difficult in a single vet practice not to have other vets around to talk a difficult case through, and forums like this are immensely helpful.

Re: Reporting cruelty - advice please

Andrew Kent — Sun, 05 Sep 2010 10:56:25 GMT

Love the yellow card Arlo - the choice of analgesia is irrelevant to this discussion and doesn't help our colleague with the situation in hand.

I think these situations are some of the hardest to handle correctly - I had a similar case last year with a client who refused treatment of a dog with acute pancreatitis - my attitude to these cases largely follows:

1. Polite reasoning - sounds like you've tried this.

2. Pointing out the clients legal obligation under Animal Welfare Act 2006 to seek and follow Veterinary Advice.

3. Advise that if they choose to ignore this you have an obligation to report this to the relevant authorities.

4. Contact RSPCA.

I would usually contact the RCVS professional conduct department somewhere between point 2 and 4 so that it is shown I have sought guidance. I have had probably a handful of cases that I have had to do this for and never actually had to get as far as contacting RSPCA, though I have certainly been close and had some confrontations because of it.

I think the important thing here is that if the client chooses conservative management (and not surgery) then that in itself is not a problem, but they must follow advice regarding resting/caging and must be on pain relief if the dog is still as lame. Obviously if the situation changes so that this requires surgery then it may be that the conservative approach is no longer appropriate. In which case they may have to consider the cheaper option of amputation if they don't want more complicated orthopaedic surgery.

As a final thought make sure you write very detailed clinical notes on this situation including what you have advised at each stage and that this has been declined. I will also often write a detailed statement separately for my own protection - these clients are often the ones who are also more inclined to try and point the finger at you if things don't go well so protect yourself first and foremost!

Good Luck!

Andy

Re: Reporting cruelty - advice please

Arlo Guthrie — Sun, 05 Sep 2010 08:21:13 GMT

And Rob:

...for the reasons eloquently described by Mark, Evelyn and Louise. It's really important that the 'atmosphere' in this forum is collaborative and completely unjudgemental.

Re: Reporting cruelty - advice please

plantagenet — Sun, 05 Sep 2010 08:11:49 GMT

[quote user="Rob Smith"]I'm intrigued that you thought NSAIDs was sufficient analgesia even overnight for a fracture. If you had a fracture, would you pop an ibuprofen and seek treatment in the morning? Couldn't you at least have given buprenorphine?[/quote]

I didn't think it was broken at that stage. We did put in on further pain relief after xray.

ED'S NOTE - I HAVE POSTED THIS ON BEHALF OF PLANTAGANET, WHO ACCIDENTALLY REPLIED BY EMAIL LAST NIGHT (INSTEAD OF REPLYING ON THE SITE).

Re: Reporting cruelty - advice please

Louise6732 — Sat, 04 Sep 2010 23:48:15 GMT

Rob, perhaps you don't mean to be so cutting, it's just that we can't ascertain your tone from text alone.

Harsh and overall negative comments about what others have said only serves to discourage those less confident in their clinical skills or opinions to participate. The whole point of this forum is discussions, which cannot be as beneficial with only a few participants.

Perhaps constructive criticism would be a better way to approach things. We are all human, after all.

Re: Reporting cruelty - advice please

Evelyn Barbour-Hill — Sat, 04 Sep 2010 23:23:50 GMT

OK folks, from now on it's to be "defensive posting" please. If you are outlining a little case history, don't be totally honest or truthful about what you did. For instance, don't specify your analgesic treatments, just say analgesia was given. As an alternative, write a brief thesis (say 300 words) explaining the reasoning that led to every one of your diagnostic decisions and the reasoning that led to every one of your therapeutic decisions, and add a grovelling apology in advance to all of us, who were not there at the time but will be pleased to criticise you rather than helping with your question.

Re: Reporting cruelty - advice please

Rob Smith — Sat, 04 Sep 2010 21:31:20 GMT

[quote user="Utlendigur"]

No, you wanted to know why only nsaids were given for a fracture - at a point when a fracture hadn't been diagnosed - to be pedantic.

Nb the dog is 6yrs old, not a puppy - could equally be a cruciate, cellulitis, flare up of DJD, strain/sprain. A non-displaced tibial plateau/crest # is not going to be diagnosable clinically.

[/quote]

Whatever the cause, likely to be rather painful if 10/10 lame

Cruciate - should be able to diagnose on clin exam

Cellulitis - should get hints from clinical exam, eg pyrexia

Flare up of DJD - no, this does not cause a dog to go from 0/10 - 10/10 lame

Strain/sprain - dustbin "diagnosis"

Re: Reporting cruelty - advice please

Mark Holmes — Sat, 04 Sep 2010 20:47:05 GMT

The op says 6 yr old dog not puppy as far as I can see. NSAIDs quite appropriate analgesia for a 10/10 lame dog to be seen the following day. Having said that had it been a puppy they do go 10/10 lame over very little and are often running around fine with some NSAID and a couple of hours to forget about it. I am always very cautious about bring overly critical about a case from a distance. The Karma police have a nasty habit of kicking you in the nuts.