Practice Management
What to Do When a Client Files a Malpractice Complaint
By Paul Basilio
Accusations of malpractice can strike fear into veterinarians and cause them undue emotional and financial burden. The filing of a state board complaint against a veterinarian can take minutes, but how the veterinarian responds can mean the difference between an open-and-shut case and one that is seemingly never-ending.
There are 2 basic options for clients to file claims of malpractice. The first is to file a complaint with the veterinary state board, which is as easy as sending an email. The veterinarian will have to write a response, they may have to show up to a hearing, and they may have to pay a fine.
“As a general rule, veterinarians are exonerated in these investigations,” said Charlotte Lacroix, DVM, JD, during a presentation at the 70th AAEP Annual Convention in Orlando, “The thing that you’re almost always found culpable of is failing to maintain appropriate medical records, so you should be prepared to pay the applicable administrative fine.”
The other way is through tort law, in which the accuser will hire an attorney and have another veterinarian testify that the treating veterinarian’s actions were negligent (i.e., below the standard of care). Clients are less likely to bring these type of cases against veterinarians because they must pay for legal and expert fees, which are expensive, unless the claim involves personal injury or a valuable horse.
“Since disgruntled clients are more likely to file a complaint with the veterinary state board, it is important that equine practitioners have license defense insurance that covers their attorney fees in defending their actions before the board,” Dr. Lacroix explained. “And make sure you do have it, because that’s the path of least resistance for a disgruntled client.”
What is Negligence?
Negligence means that the veterinarian did not provide treatment, skill or diligence that’s recognized as the prevailing standard of care—i.e., the veterinarian failed to do what they were supposed to do, or they did something they weren’t supposed to do.
In reality, standard of care varies depending on the facts and circumstances.
“Veterinarians have all had similar cases of lameness that were managed differently because of the nuances in managing those cases,” added Dr. Lacroix, who is the owner of Veterinary Business Advisors in Whitehouse Station, N.J. “Standard of care is not a black-and-white thing that everyone knows.”
Protecting Against Negligence Claims
The fluidity inherent in the definition of standard of care means that veterinarians should take the time to properly record their medical findings using the SOAP (subjective, object, assessment, and plan) methodology. Dr. Lacroix emphasized that this helps the reviewer understand what the veterinarians was thinking. If someone unrelated to a specific case reads the medical record, they should be able to understand and assess the thought processes that lead to the chosen treatment.
“One of the most important aspects of any medical record is the list of differential diagnoses,” she said. “Getting the wrong diagnosis does not make you negligent. You’re allowed to get the wrong diagnosis, but you have to be thoughtful about why you went down an alternative path.” MeV
PREVENTATIVE GUIDANCE
To avoid receiving a dreaded letter from the state board or from a client’s attorney, Dr. Lacroix shared some preventative guidance.
Listen to the Client
Clients who file complaints are often angry and need the opportunity to vent. It’s important to take their complaints seriously to avoid escalation. Read the complaint, listen carefully and take notes on any conversations.
“Don’ take it personally,” Dr. Lacroix said. “Perception is not reality.”
Remain Calm and Objective
“Don’t put anything into writing stating that client is a pain and doesn’t pay their bill. No one cares. It’s irrelevant to the standard of care and will make you look unprofessional,” she said. “Contact your insurance carrier and promptly report the claim. If you don’t, it could compromise your defense.”
Dr. Lacroix stressed that most malpractice insurances consist of group policies. If the group’s claims go up, then the premiums go up. However, it’s not like car insurance, where if your individual claims go up, your premium will go up.
She also said that while most clients will not want a necropsy performed in cases where the patient died, that doesn’t mean that one should not be offered. If the client says they do not want it, then that could compromise their case against the veterinarian.
Communicate, Communicate, Communicate
Many complaints are the direct result of an uncommunicative veterinarian. Often, clients misunderstand the diagnosis or treatment, so their expectations of the outcome were unrealistic.
“The thing that gets clients angry is when veterinarians don’t return phone calls that involve upset clients, since we don’t like confrontation,” she said. “Call the insurance company first, then invite the client to the practice, triple-check that a mistake was actually made, and admit the mistake. Most clients believe you’re hiding something if they don’t hear from you, and they’re often more interested in making sure the mistake will not happen again.”
Malpractice claims are often the result of miscommunication over consent or the risks or costs associated with a treatment, so it’s important to pre-emptively communicate these things before the situation goes south.
Show Sympathy and Concern
Clients who make complaints are often emotionally distraught and may be looking for someone to blame. A compassionate veterinarian who attempts to comfort the patient may defuse the situation before it escalates.
While sympathetic statements and admission of actual mistakes are crucial, veterinarians should take care before admitting guilt. Just because there was an unexpected and unfortunate outcome, does not meant the veterinarian was negligent.
Dr. Lacroix cautioned that veterinarians should not be too quick to judge themselves. Veterinarians should not admit fault or offer excuses, as these could compromise their case in the event of a lawsuit.
“As long as you are logical and fall within the principles of medicine, you should be fine,” Dr. Lacroix explained.