Allegations of Professional Misconduct

• sold Advantix products without a veterinarian-client-patient relationship (VCPR)
• failed to supervise an auxiliary who dispensed medication
• the member’s auxiliary failed to take or record the dog’s weight prior to dispensing a pesticide/parasiticide;
• failed to keep adequate records of the sale of Advantix;
• the member’s auxiliary administered dexamethasone without the member first assessing or examining the dog, in the absence of a VCPR and without supervision
• no basis for the auxiliary to administer dexamethasone
• failed to take an adequate history and failed to properly or adequately examine and assess the dog
• failed to recommend appropriate investigations or treatment when he received the results of the bloodwork
• failed to document his bloodwork analysis
• failed to recommend an urinalysis
• failed to investigate the level of phosphorous shown on the bloodwork
• failed to consider or suggest investigating thrombocytopenia
• administered Duplocillin, an antibiotic, without any clinical rationale for its use
• placed the dog on subcutaneous fluids despite evidence of renal failure
• failed to provide the dog with intravenous fluid therapy and other intensive supportive care
• failed to support the dog’s nutritional status
• failed to outline the prognosis and potential outcomes to the owner
• failed to obtain informed consent to treatment
• failed to monitor or assess the dog adequately throughout the dog’s time at the hospital
• charged approximately $830 for treatment without providing an estimate or obtaining authorization from the owner
• failed to maintain proper records
• failed to maintain the standard of practice of the profession
• failed to direct or supervise, or inadequately directing or supervising, an auxiliary
• permitted, counselled or assisted a person, other than a member, to practise, or to attempt to practise, veterinary medicine
• permitted, advised or assisted a person, other than a member, to perform any act or function which should properly be performed by a member
• an act or omission relevant to the practice of veterinary medicine that, having regard to the circumstances, would be regarded by members as unprofessional

Brief Summary

An individual attended the member’s hospital to purchase flea treatments for two dogs. The individual was not the member’s client or a client of the hospital. The member did not meet with the owner when the Advantix was purchased from the member’s auxiliary. The auxiliary did not obtain or record the weights of the dogs before dispensing Advantix.

The member’s records do not specify what form of Advantix was sold or what form or quantity each dog was to receive.

After the owner administered Advantix, one of the dogs became ill. The owner bathed the dog to try to remove the product and took the dog to the hospital as its condition deteriorated. The member’s auxiliary administered “Dex 2 – 1 ml” (presumably dexamethasone) to the dog. The member had not examined the dog before the drug was administered.

The owner spoke to the member the next day and advised the member he could not afford expensive treatments but agreed to bloodwork. The results suggested acute kidney injury or acute kidney failure. The member administered subcutaneous fluids to the dog. During the dog’s admission to the hospital, either the member or his auxiliary administered Duplocillin.

The owner advised the member he had concerns about the cost of treatment and felt pressured to agree to hospitalization. The owner advised the member the hospital would be responsible for the costs of treating the dog.

The dog’s condition continued to worsen. The member advised the owner the dog was experiencing kidney failure. The owner asked for the dog to be euthanized but the member persuaded the owner to continue treatment. The dog did not improve and the owner again asked for euthanasia, which was scheduled that day. The dog passed away prior to the euthanasia. 

The owner received an invoice from the hospital for approximately $830 for various veterinary services. The member had not provided an estimate to the owner.

Decision

The member pleaded and was found guilty to the allegations of professional misconduct.

Penalty

• Reprimand
• The member shall not engage in the practice of veterinary medicine for two months.
• Required to complete a half-day assessment to evaluate the member’s knowledge regarding supervising an auxiliary and record keeping.
• Required to participate in a one-day mentorship on the veterinary medical issues and communications issues that arose in the case.
• Completion of the College’s learning module on medical record-keeping in companion animal medicine.
• Peer review of medical records
• A half-day assessment by the assessor to evaluate the member’s baseline knowledge regarding supervising an auxiliary and record keeping that were raised in the case.
• Must pay costs to the College in the amount of $5,000

Panel's Reasoning

Medical Records: The Panel reviewed the records provided. The notes demonstrated the drugs were dispensed by an auxiliary without a VCPR. The record included an assessment of the dog and a plan, but no diagnosis or recommendations and no client communications were included.  The results of the blood work were provided but without an interpretation of the results or hypotheses to explain the abnormalities. There were no recommendations for follow-up testing or further investigation and no client communications.  The record included photocopies of the invoices, however there was no evidence the owner consented to charges (beyond the original request for Advantix).  

The Panel reviewed the independent opinions. Where the experts’ opinions differed from the Agreed Statement of Facts, the Panel considered the reasons for those differences.  

The College expert agreed the evidence (invoices and notes in the medical records) showed inappropriate dispensing of Advantix – incomplete information on the product recorded, dogs were not weighed and dispensed by an auxiliary to a person without a VCPR and concluded that the member failed to meet the standard of practice. The member’s expert agreed with most issues but disagreed the member failed to keep records of the sale – but did agree that the records were not accurate. The Panel is satisfied both expert opinions support findings for the allegations.  

The experts agreed the auxiliary inappropriately administered dexamethasone to an animal without it being assessed by a veterinarian and without a VCPR.

The College’s expert was of the opinion the member failed to meet the standard of practice for a dog with renal failure by not providing intravenous fluids, not properly investigating, assessing and/or treating the severe changes on the bloodwork (e.g., azotaemia and thrombocytopenia), providing inappropriate therapy (duplocillin, dexamethasone), and failing to properly record assessments in the medical record, as well as his interpretation and plans with regards to the abnormalities found in the blood work.  The College expert also agreed the member did not meet the standard of practice by failing to recommend to the client that a urinalysis be performed.

The member’s expert disagreed that this was the standard of practice in this case. The member’s expert agreed the member failed to take an adequate history or to properly examine the dog and failed to properly document analysis of the bloodwork. He also agreed treatment with dexamethasone was not warranted. The member’s expert did not agree the member failed to properly investigate or treat the abnormalities of the bloodwork, nor that duplocillin and subcutaneous fluids were inappropriate treatments.

The opinion on support for the dog’s nutritional status differed between the experts with questions around whether a feeding tube should have been provided and other less invasive ways to offer nutritional support.

Both experts agreed that because the member did not provide an estimate to the client; didn’t obtain informed consent to treatment; and didn’t provide clarity on what charges would be borne by the hospital, the member did not meet the standard of practice.  

Both experts agreed there were numerous deficiencies in records with the lack of information in the records making it difficult to know if case management was appropriately performed.  

The Panel finds that the member’s conduct was below the standard of practice for the profession and was unprofessional as it demonstrated a serious and persistent disregard for their professional obligations.

Reasons for Penalty Decision

The proposed penalty provides for deterrence through the oral public reprimand, and a two-month suspension. The proposed penalty provides for remediation and rehabilitation. Specifically, the one-on-one mentorship on veterinary medical and communications issues will promote the member’s knowledge and skills on case management and should serve to improve his communications with his clients.  Completion of the College’s medical records learning module, followed by an evaluation of his subsequent medical records by an independent peer reviewer, should serve to assure the member’s medical records meet the standard of practice in the future.  

Finally, the member will undergo before and after assessments regarding the issues of supervising an auxiliary and of record keeping that were raised in this case.  This will assure the member has learned from the required remediation and rehabilitation.

The Panel is satisfied that an order for costs of $5000 is appropriate.  The costs are in-line with other uncontested cases and are reasonable in the circumstances.

In summary, the Panel concluded the proposed penalty is reasonable and in the public interest. The member has co-operated with the College and has accepted responsibility. The Panel finds the penalty satisfies the principles of specific and general deterrence, rehabilitation and remediation, and public protection.  In particular, the Panel is satisfied the terms and conditions imposed make it clear to the member the necessity of proper supervision and use of auxiliaries in practice, the critical importance of keeping complete and accurate records and obtaining written informed consent before proceeding with diagnostics and treatment.  It also supports mentoring the member in case management and assessing his knowledge before and after completing the rest of the terms and conditions.

Decision

Since 2024, decisions have been posted on the CanLII website, the Canadian Legal Information Institute. A complete copy of this decision is available on CanLII.