Protecting Your Practice From Litigation (2024)

When legally evaluating professional negligence, standard of careis the benchmark used to assess veterinary competence. This standard is reached by veterinarians performing their duties with the same degree of skill, care, and diligence as exercised by colleagues practicing under similar circ*mstances. Unfortunately, this general rule is not always helpful when determining whether a veterinarian has been professionally negligent.

Two areas of law primarily regulate veterinary conduct and help ensure that veterinary professionals act prudently and reasonably when treating animals and interacting with clients.

1. Thecivil court systemadjudicates client claims regarding alleged negligent conduct.
2. Thestate board of examiners, an administrative office charged with enforcing each state’s veterinary practice act and regulations, sets forth laws regarding both obtaining and maintaining veterinary licenses.

When complaints are filed, veterinarians can receive distressing letters from the state board of examiners and/or attorneys representing disgruntled clients. The initial reaction to respond impulsively is not in the veterinarian’s best interests. Recent graduates are especially vulnerable because they have limited experience and often lack confidence when reacting to such allegations. How veterinarians respond can have a significant impact on the outcome of the case; therefore, it is important to clearly understand how state boards and courts adjudicate allegations.

RESPONDING TO MALPRACTICE ALLEGATIONS

How veterinarians respond to allegations will depend upon whether the allegation is related to a lawsuit, state board complaint, or both. Regardless of the type of allegation, veterinarians must:

• Determine what has been requested and by what date a response is required
• Gather pertinent medical records and other relevant documentation
• Prepare a chronologic recollection of events
• Review medical records to corroborate events.

In Dr. Steel’s case (seeMartinique: Misdiagnosis to Malpractice), because documentation was poor, the case comes down to Dr. Steel’s word against Ms. Bridges’. Dr. Steel will have difficulty claiming he provided adequate information to Ms. Bridges as there is no indication of this conversation in the medical record. Since Dr. Steel has a legal obligation to maintain complete medical records—as dictated by state board regulations—neglecting to do so implies he may also be a careless medical care provider.

Contacting Insurance Carriers

Continuing to use Dr. Steel’s case as an example, upon receiving the letter from Ms. Bridges’ attorney, Dr. Steel should immediately contact his professional liability insurance carrier. However, if Dr. Steel suspected Ms. Bridges was likely to pursue legal action prior to receiving legal notice, he should have contacted his insurance carrier at that point.

Insurance carriers differ in how they handle negligence actions, but typically require the defendant to complete a form describing the circ*mstances leading to the complaint. Then, claims representatives review the facts, recommend a course of action, and may assign an attorney to the case if the complaint cannot be settled quickly. For example, if Ms. Bridges rejected a settlement, an attorney would be assigned to defend Dr. Steel since, upon review, his care appeared to be substandard.

Handling State Board Investigations

Regarding the state board investigation and allegations, Dr. Steel likely will need to defend his conduct at his own expense because professional liability insurance carriers generally do not provide coverage for state board actions (an exception is the AVMA-PLIT, which offers a limited policy that insures against state board actions). He could respond on his own, but may put his professional career at risk by neglecting to obtain legal advice, including an attorney’s review of the response he submits to the state board.

Dr. Steel should also consider consulting other veterinarians that work within small animal practice to determine if they:

• Inform clients of their level of experience with exotic patients
• Offer referrals to more experienced exotics practitioners
• Make note of these conversations in the medical record.

This information would help Dr. Steel determine whether he acted within the standard of care for Martinique.

Dr. Steel should not underestimate the time and effort required to address all the issues—in an organized and articulate manner—in the complaint.

Disorganized or incomplete responses often lead to further board investigation rather than early dismissal.

HANDLING CLIENT COMPLAINTS

Clients often resort to litigation and/or state board action when they believe their veterinarians acted negligently or failed to respond appropriately.

When faced with an upset client or complaint, follow the steps below:

1. Listen to the Client

   • Clients with complaints are often angry and need to vent.
   • Demonstrate that you consider the matter serious by taking notes during the conversation.
   • Do not interrupt the client; interruptions only create more frustration and will likely interfere with a clear understanding of the facts.

2. Remain Calm and Objective

   • Avoid becoming defensive and emotional, as this may inadvertently reinforce the client’s belief that his or her veterinarian provided inappropriate care.
   • Remember, a client’s criticism of your actions, even when fully justified, does not necessarily mean that negligence occurred.

3. Communicate, Communicate, Communicate

   • Veterinarians often fail to adequately communicate; clients may not fully understand the diagnosis or proposed treatment, or have unrealistic expectations.
   • Obtain informed consents, provide fee estimates, encourage questions, and review handouts with clients that explain services.
   • Avoid medical jargon that can confuse and intimidate clients, making them reluctant to ask important questions.

4. Show Sympathy and Concern

   • Clients whose pets have died are often emotionally distraught and may seek to place blame. By comforting a client who has lost his or her pet, you are likely to defuse the perception that someone should be held accountable for the pet’s death.
   • Recommend grief counseling for clients who appear to have difficulty coping with their loss. Several veterinary schools have grief hotlines (seeVeterinary University Grief Hotlines).

5. Coach Your Team

   • Staff members can help defuse client complaints. Teach them the principles described above.
   • The veterinary team should remain professional at all times and avoid “offensive–defensive” discussions with clients.

6. Do Not Admit Fault or Offer a Settlement

   • These actions could compromise the case if a lawsuit is filed.
   • Do not agree to any settlement offered without first contacting your insurance carriers and attorneys; otherwise, your agreement may be interpreted as an admission of fault.
   • It may be appropriate to reduce the client’s bill to amicably and expeditiously resolve a dispute without admitting liability.

AVOIDING CLIENT COMPLAINTS

Regularly consult with staff, colleagues, and insurance carriers to identify preventive measures and new developments in the legal liability field that can help avoid potential complaints.

The key components of these measures include:

• Communicating concisely and clearly with clients
• Keeping detailed written records (eg, case notes, consent forms)
• Providing high quality medicine that meets or exceeds standards of care.