Dental disaster sinks teeth into veterinarian

Dental disaster sinks teeth into veterinarian

Transparency helps avoid nasty client surprises.
Jan 26, 2015

Dr. Clery had owned a two-doctor small animal practice for 28 years. He didn’t bother with social media—no Facebook or Twitter presence for him. Rather, he believed that compassionate, competent pet care was the key to a successful practice. He took time to communicate directly with his clients and their pets. He thought forms and releases hindered his ability to treat his clients and patients like family. Pet birthday cards and informational reminders had served him for all these years.

Fluffy Hacket, an 11-year-old poodle, was recently diagnosed with dental disease. Ms. Hacket was distressed at the news, but Dr. Clery patiently explained that older small-breed dogs often required dental care even when cared for by the most diligent of owners. He told Ms. Hacket that Fluffy might need an extraction or two, and the tartar needed to be removed from his teeth. “Will it affect his smile?” she asked. Dr. Clery replied, “Just leave things to me. I’ll take good care of Fluffly.”

Once Fluffy was anesthetized, intubated and prepared for his dentistry, Dr. Clery began the procedure. He evaluated the dog’s mouth and began to remove the extensive calculus from the teeth. As is often the case, the tartar removal revealed loose, unsalvageable teeth that were essentially being held in place by the calculus buildup. Dr. Clery began doing the necessary extractions. After all was said and done, Fluffy had lost 16 teeth. Dr. Clery thought to himself, “This dog is going to feel a heck of a lot better.”

Fluffy recovered uneventfully, and the practice let Ms. Hacket know that her beloved dog could go home that evening. Chief technician Lea Johns personally discharged all dental patients and allowed ample time for post-procedural questions and instruction. Ms. Hacket arrived with Fluffy’s doggie coat and stroller. She met with Johns, who told her the dog had lost 16 teeth due to severe dental disease that was not discovered until Dr. Clery was well into the procedure.

The color drained from Ms. Hacket’s face. “Sixteen teeth! What have you done to my dog?” she shouted. She’d been prepared for the loss of a tooth or two, but 16 was unbelievable. “Why didn’t the doctor call me so that I could participate in the decision?” she asked. At this point Dr. Clery came in to speak with Ms. Hacket and explained the necessity of the extractions. But the client was inconsolable. “You never told me what you might have to do. You could have consulted with me before pulling all those teeth,” she said.

She went on to say that the actions of the practice were unforgiveable. “You have not heard the end of this, Dr. Clery,” she said. She and Fluffy exited the office in a huff.

Soon afterward, Dr. Clery received a notice from an attorney as well as a letter of inquiry from his state board. He was upset at this turn of events but confident that he’d done the right thing. He believed the patient’s well-being and medical needs prevented him from stepping away during the procedure to call the pet owner. In addition, he had informed Ms. Hacket of the dental disease and she’d agreed with his request to “to leave things to me” to take care of. The state board wrestled with the case but concluded that Dr. Clery had not violated any state practice statues.

The civil action did not end as well—Dr. Clery’s insurance carrier agreed to settle a significant amount of money on Ms. Hacket. Dr. Clery wrote off the whole series of events as the result of an extreme overreaction from a pet owner and ultimately believed he’d done his best for the dog in spite of the chaos Ms. Hacket created.

Do you agree with Dr. Clery?

Rosenberg’s response

Never forget that there is always a pet owner attached to the patient. The clinician is always caring for both the owner and the pet. In this case, Dr. Clery forgot that the owner was part of the treatment protocol. When he discovered that many extractions were necessary, he should have called and consulted with the owner. In addition, he should have presented an informative release form for Ms. Hacket to sign so that everyone was aware of the agreed-upon medical care. Forms and releases do not prevent a veterinarian from treating his clients and patients like family, but rather it offers the courtesy of written documentation for all to consider. This assists in a complete understanding of the pet’s care.

Dr. Clery was well-intentioned, but he was wrong. “Just leave it to me” was a statement made by doctors years ago when propriety dictated that a doctor never be challenged. In this day and age, honesty and transparency are the secret to quality pet care and satisfied clients.

Stage the procedure

I always recommend staging the dental procedure. It makes for a sane schedule, sane estimate, shorter procedures, and no surprises. It means talking to the owner ahead of time and letting them know that the dental examination under anesthesia (with dental radiographs) will reveal what the next steps/options are for the patient. And an exit appointment with the owner to carefully talk about the findings, radiographs, treatment options and estimates/medical plans for the future. While medically, the correct therapy may be to extract, procedures without permission are big trouble. Especially for long standing disease such as periodontal disease, assessing and cleaning the teeth, even the teeth that will be extracted, is medically beneficial to the patient. Even 1 week after a dental cleaning, the surgical site for extractions will be much improved. Making decisions over the phone is unfair to the patient while waiting under anesthesia and unfair to the client and vet (as you try to explain why this needs to be done and the cost). (And then there is the busy schedule that you and your staff already has. And have you had lunch yet?) Several shorter surgical procedures under shorter anesthetic episodes is better than a long marathon session. We as vet professionals really want to help our patients be healthy and we feel the need to fix everything NOW, but try staging and you'll be surprised how much better these cases go.

Been there, but on a different note..

I worked for a "country" vet for 20 years and not once did anyone fill out an estimate form. However, I know that medicine has grown and so have litigation's. As DavetheVet said, it's a same that medicine has to be practiced on the defensive.
I had an incident where we took in a cocker spaniel that was full of fox-tails. You could see them sprouting out of every toe and all over the legs.
The vet (I'm a RVT) explained to the owner that we would be shaving all four feet and up the leg a little ways to get to all the holes the fox-tails had made so we could remove them.
He asked us to shave the ears inside as well.
When I took the dog out to the owner, happy and wagging his tail, the guy flipped out about how "weird" his dog looked and proceeded to yell at us that he never agreed to having the feet shaved.
My boss came out and asked him what part of "We are going to shave all four feet" didn't you understand? The guy ranted on and then paid his bill. Luckily for us he was from out of town and never came back.
My boss retired rather than deal with the way Veterinary Medicine has become.
I don't really blame him one bit...

Freakishly Familiar!

I had a VERY similar incident although the owner HAD signed forms and we DID try to call during the procedure but the owner didn't answer the phone. We left a very detailed message on the phone, yet the owner never even called back. I proceeded with what I would have done on my own dog and pulled several teeth. I figured if cost became an issue we'd work something out or even discount it down to a normal cleaning if it came to that, I just couldn't leave the teeth in that horrible shape. (I have had this happen before a time or 2 and the owner's were SO grateful that I did what was best for the patient and apologized for not being available at the number they said they would.) So we finished procedure and woke patient up and called owner to inform patient was awake and well and what we had found/done/etc. The owner didn't answer post-op call either! When she showed up to pick up the patient, she threw a dramatic fit. I tried to explain to her (without accusations) how bad the teeth were and how much happier and healthier her pet would be and that he would feel soooo much better. Her response was "I don't care, you didn't have my permission to pull the teeth." Thinking it MUST be about the money and still feeling good about my decision to do the right thing for the dog, I told her we would not charge her anything more than the routine dental. She then informed me it was NOT about the money, although she was NOT going to pay me anything. She then took the drama up a notch and began to announce she was going to vomit and proceeded to the bathroom and made vomiting noises as loud as she could (must have been the special vanishing vomit, though, because she never flushed the toilet or turned on the sink, just came back out and continued the drama yet bathroom was spotless - wish my kids had that special vanishing vomit). When her embarrassed husband agreed to at least pay us for a routine dental, she left the clinic walking down the road (we are in a rural area - no sidewalks). Fortunately, that was the last time we saw (or heard from) them. I guess it could have been worse. I can't help but wonder, though, if the owner felt foolish a few days later when she saw how much better her dog was.

I think we ended up changing wording on our forms after that getting even MORE specific about what would be done if they couldn't be reached at the number(s) they left.

Dental Disaster

This very thing happened to me last year. As a result, I schedule an appointment with all dental procedures on the morning of the procedure. I re examine the mouth at that time and give the owner an estimate of what needs to be done and the approximate cost. I inform them that calling during the procedure extends the anesthesia time and potentially increases the cost of the procedure. If they are not in agreement, then I don't do the procedure. I feel that if the client can't trust me to do the right thing, we shouldn't even begin. This whole ordeal has left me a little jaded and a little less trusting of my clientele. It's a shame we have to practice in such a world, but this is the reality of it and we must practice defensive medicine.