Few equine veterinary services are more worthy of forethought than the prepurchase exam. Why? Equine veterinarians I talk to agree that this particular service creates one of the greatest risks of liability in their practices. That alone should inspire caution in moving forward.
Of course, it starts with the clients and how much they're willing to pay for an experienced veterinarian. While new veterinary graduates may be able to cross all the "t"s and dot all the "i"s in providing this exam, they may not be as capable of identifying certain problem areas; for example, the many nuances of foot- and leg-related concerns. They may be completely adequate in vetting the purchase of a quality 4-H horse for someone's son or daughter, but not at all ready to determine whether a 5-year-old racehorse has any gas left in its tank.
After that, we're onto the veterinarian's responsibilities:
1. Think through your own bias
First, make sure you know who the buyer and seller are, and remind yourself you're working for the buyer. You'll need to be unbiased and report all your findings in a transparent fashion. Some veterinarians won't perform prepurchase exams if they have a pre-existing relationship with the seller and/or the horse.
2. Verify the horse (no joke!)
Secondly—and this is overlooked by some—verify that the horse you’re examining is the horse the seller says it is. Ben Braat, DVM, an equine veterinarian with more than 50 years' experience in Oregon, says three times in his career he's discovered that the horse he was examining didn't match the papers provided.
3. Completely assess
The exam itself should be built on the foundation of a complete and comprehensive assessment. No clinical sign should go unnoticed. Many practitioners prefer to conduct these exams at their own facility, where they can observe movements on the footing surface of their choice. Lunging as well as trotting after flexion are typical components of the exam.
4. Offer the tests
According to Braat, most mistakes threatening liability are made by failing to offer all available diagnostics, such as blood tests and radiographs. Of course, some of those services may not be as critical, depending on the sale, but that decision should rest with the buyer. Document in writing that you offered the services and that the buyer authorized or declined them.
Regardless of any lab work elected or declined, maintaining a blood sample at least a few weeks into the future is also a good idea. Occasionally, the buyer will report that the horse's behavior after the purchase does not match the behavior exhibited during the exam. Having a frozen serum sample on hand will facilitate any testing to decide whether the horse was being chemically altered at the time. Some practitioners may include this testing as a routine part of their exam, checking for the presence of analgesic and/or anti-inflammatory drugs. When discussing lab work, remember to ask whether the horse will be relocating to another state based on the purchase. This is a good time to make sure that a Coggins test is current, a detail some buyers forget.
5. Make no guarantees
Braat says the work the horse will do after the purchase is always a key component in his prepurchase exams. But he cautions against making any promise or guarantee that the horse will be specifically suited for that. You can never know for sure what the horse will wind up doing, how much and in what conditions or under what treatment.
6. Communicate well
Communicate directly with the buyer before and during the examination—whether the buyer is physically present, the seller is physically present, or both are absent. Good communication makes it easier for the buyer to make decisions as an exam progresses—and could end up saving a buyer money in the long run. If the veterinarian finds concerning problems right away, the buyer certainly should have the option of pulling the plug on the purchase, especially if hundreds of dollars in radiographs are planned later in the exam.
7. Manage signatures and security
The final step is making sure you have the buyer’s signature—when present—on a statement confirming that all information provided is true and accurate to the best of their knowledge and that they understand the information provided by the veterinarian during the exam.
After the exam is completed, it’s also very important to maintain security of the medical record. This is one scenario in veterinary medicine where the records don’t belong to the owner of the animal. When potential buyers hire a veterinarian to provide this service, they alone have the legal right to the findings and written report. This can be confusing as that party can be out of state and not previously represented in your client/patient files. When that's the case, it’s time to make a new file.
This becomes especially important when the horse “fails” the prepurchase exam. The seller may ask to use the report to facilitate a future potential sale, even though the report could be irrelevant even days later. Instruct your practice staff to use the highest level of discretion when providing copies of this report to a third (or second) party and only when the buyer is willing to release the report. Make sure you get that permission in writing.
8. Watch for the bait-and-switch
Finally, institute a clear practice policy on how to deal with clients who are buying horse and try to do an “end run” around the cost of a prepurchase exam by scheduling a regular exam to save money. You may have no problem with doing so as long as the expectations are clear and you only intend to provide the same examination you would for any other horse. Don’t be surprised, however, if the client slowly tries to convert your findings into a nondocumented prepurchase exam report.
Providing prepurchase exams can be a lucrative part of any equine practice, especially if diagnostics are included. With a good policy and approach to the above concerns, practitioners can embrace this revenue stream, which appears to be increasing with the slow recovery of the equine economy.