Legal liability is a potential problem for every business person, including health professionals such as veterinarians.

It is easy to imagine why more complex business organizations have more legal risks. A greater number of manufacturing facilities creates more opportunities for injury, and more customers result in more complaints and potential lawsuits.

Likewise, in a large veterinary practice, the size factor itself — increased personnel and the splintering of management responsibilities — can create legal risks that smaller practices usually don't face.

Reduced continuity of care

To illustrate, consider this brief analogy involving the human-health field:

I recently spent a few days in the hospital, where I became particularly aware of how confusion and lack of communication can delay, complicate and even derail a treatment protocol.

Many modern hospitals have created a new physician job title, the "hospitalist." (The term is so new that the spell-check on my computer doesn't recognize it.) That was done to accommodate the fact that, today, primary-care physicians frequently don't come to the hospital to see all the patients they have admitted. Instead, these patients are placed in the care of a group of physicians who do nothing except manage cases admitted by others.

The larger the facility, the bigger the group of hospitalists. In my recent experience, these doctors often have so little familiarity with the patients that they visit some without having seen even their medical records.

Apparently I needed fluid therapy and blood work due to dehydration. The emergency-room doctor accepted me from my internist, whom I had visited in the early afternoon.

The ER ordered my admission for LRS and intravenous antibiotics. That was around 4 p.m.

At midnight, I had been in my hospital bed for eight hours, and there was no IV in sight. Also no food, water or even ice chips.

Finally, I demanded to know why and was told that no hospitalist had written an order for any of those things and therefore I couldn't have them until there was an order.

When I finally insisted that I wanted treatment or I wanted to go home, a nurse agreed to pester the hospitalist staff to come see me.

Finally, a doctor I had never met wandered in and asked how I came to be admitted to his floor.

Once I brought that hospitalist up to speed on my medical condition, I got my juice and my IV. I never saw that hospitalist again, but I did see many others who dropped in once, never to return.

Large veterinary practices

Now, I guarantee that if this degree of disconnect can happen in one of the finest hospitals in the country, it can happen in private veterinary practice.

The truth is that similar problems are not uncommon in the large veterinary-practice setting.

In a one- or two-DVM practice there is constant personal communication and discussion about admitted patients (of which there tend to be fewer anyway), making it fairly hard for a patient's medical or observation needs to fall through the cracks. Each critter generally is known by name, at least by the support staff, and there tends to be a strong personal relationship between each patient and the doctor and technical staff who have been working on it since admission.

However, when there are multiple doctors working on the same animal over several days with multiple shifts of support personnel, it is not difficult for patients to get inadvertently overlooked or undertreated.

I have worked in large hospitals where there were multiple cases presenting with the same primary rule-out diagnosis. Whether it's parvo or lepto, it is not all that difficult to confuse which case is getting better and ready to be treated more conservatively and which is practically ready to expire. The order of treatment can be affected so that the sick patient can go to critical before the client has been notified of the unfolding crisis.

That can lead to lawsuits even when nothing could have saved the patient.

I can tell you from years of experience that just as many malpractice lawsuits arise out of poor observation practices and lack of client notification as from alleged negligence.

The closer we come to being "hospitalists," the greater the risk of inadequate case oversight, poor client contact and lawsuits.