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The price of pain
How a veterinarian facing license revocation exposes an unwritten mandate to treat animal pain


DVM360 MAGAZINE


"An allegation has been made that the failure to provide prophylactic pain management just because an animal has undergone a procedure is somehow below the standard of care," he says. "This case is almost antithetical to the concept of pets being considered personal property. If you have an automobile and say 'I want the basics,' the repair shop will give you the basics. Under the law, veterinarians should still be allowed to do that."

Imminent threat

Not so, when it comes to pain management, argues Dr. John King, MBVM executive director. Appointed by the governor, the seven-member board temporarily suspended Seemann's license based on an investigation and interviews with the veterinarian, King says. He insists such action isn't the product of "unharnessed power of the bureaucracy." Out of 3,000 Minnesota licenses, authorities revoke one every couple of years.

Seemann's case marks the state's first suspension, and his alleged failure to use post-operative pain drugs is egregious, King says. At trial, the attorney general's office representing MBVM called on a University of Minnesota professor to describe the teaching hospital's modus operandi on pain control. Critics argue that such strict standards don't yet apply to practitioners in primary-care practices, especially in rural settings. Still, "this is not about failing to give pain medication for a hangnail. This is about orthopedic surgery," King states.

While King acknowledges that the state's practice act does not include pain-management rules, he argues, "Nothing in there talks about how to spay a dog, either." Lic-ensing agencies struggle with how to enforce variable benchmarks, especially when standards of care are fluid, he says. But to hint that enforcement hinges on mere personal opinion is too simplistic a view. Dr. Robin Downing, president of the International Veterinary Academy of Pain Management and an author of the recent AAHA/AAFP pain-management guidelines, insists such standards of care are part of the profession's "collective consciousness." Seemann's case, she says, represents the first time a veterinarian has been confronted with a disciplinary action solely for lack of pain control and acts as proof that a doctrine exists for pain management.

"I will tell you that we in veterinary medicine now have enough data published that it is inexcusable for any veterinarian not to have a clear understanding that it's necessary to help a patient be comfortable following surgery," she says. "If there are five practices in a community and three embrace the guidelines, they have effectively raised the standard of care in that community. Those two other practices will be judged in that context."

Considering that analogy, "it appears Dr. Seemann was asleep at the wheel," King contends. "Our bottom line is to protect the public. People shouldn't believe that if they live in Podunk the practice of medicine is anything less than in the city," he says.

Out of bounds

Yet the board's "take no prisoners" approach isn't wise or lawful, critics maintain. Despite knowing that his opinion might be unpopular among specialists, James F. Wilson, DVM, JD, testified on Seemann's behalf. Without any widely uniform, disseminated rules on pain management, the board's suspension should be ruled invalid, he contends.

"Dr. Seemann is being treated harshly by the state board and lashed by the attorney general's office," Wilson says. "If the suspension is upheld, I believe this represents a new legal precedent for the nation of primary-care veterinarians who are not yet aware of their vulnerability to this cause of disciplinary action."

Wilson hopes surveys will be conducted to determine what the standard of care really is among practices in the United States. "After all, when does a new course of treatment become the standard?" he asks.


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