Friday, January 27, 2012


Almost all the veterinarians I know carry professional liability insurance through the AVMA's Professional Liability Insurance Trust. Yes, I said *almost,* so, calm down, you crazy cowboys out there (you know who you are). To keep their insured members aware of what types of things veterinarians get sued for, they publish a newsletter a few times a year in which they describe interesting cases in which a veterinarian got sued for something and was either found liable or not liable for the client's loss. 

I'm going to take a moment here and just mention something unrelated to the major point of this article. The fact is, in the USA right now, in most jurisdictions, pet dogs and cats are valued as property (this may be changing, as a recent ruling in Texas ascribed "special value" to pets, but for now, it's generally true). This limits the liability of the veterinarian, in general, and makes our liability insurance much more affordable compared to that of, say, an OB/GYN, or your favorite neurologist. This is nice for veterinarians, and helps us to keep our costs down. If or when the legal climate changes, and pet owners become more likely to win larger judgements against veterinarians, insurance costs will rise, and veterinary costs will rise, and pets will get less care because people won't be able to afford it. But that should all be covered in a separate and much more depressing blog post than this is intended to be.

Moving on.

So some time last year, I read a case in one of these PLIT newsletters about "Dr. B." 

Basically, someone brought their cat to Dr. B for a routine exam and vaccines. The owner helped the tech weigh the cat, and when the cat got off the scale, the owner thought it might be falling and moved to redirect it. The cat at that time bit and scratched the owner's hand. The technician cleaned and wrapped the hand for the owner, and Dr. B told the owner to seek medical care from a physician. The owner then left with the cat. Within 24 hours, the owner’s hand became infected, and it failed to respond to treatment quickly. At that time the owner called Dr. B and requested Dr. B pay for out-of-pocket medical expenses. Dr. B reported this to PLIT and consented to settle; claim review was performed, and it was determined that it was BELOW THE STANDARD OF CARE TO LET THE OWNER ASSIST WITH HANDLING THE CAT DURING THE EXAM, and they recommended settlement. Long story short, this ballooned into a big deal because the owner's hand was very badly injured and needed to have multiple specialists involved and trips to the ER and home nursing care and so on. In the end, PLIT paid over $22,000 to the cat owner (and the cat owner's health insurance company, which had pursued subrogation) to close the claims.

"OK, well, that sucks for them," you might be saying right about now. "Why are you telling me this story, Dr. VBB? And why is that bit about the owner assisting being below the standard of care in bold all-caps, anyway?" you inquire. Well, I'll tell you why. This concept of owner handling and/or restraint of the pet during a veterinary office call comes up every day in my office. It is the rare client who willingly lets go of his or her pet and allows my staff to restrain it! Every day in my office we have something like this happen:

Me: [walks into room. owner is holding pet in arms or on lap.] Hi there! Good to see you! Can you put Fluffy on the table for me?
Client: Sure [puts pet on table]
Me: OK, I'm going to examine Fluffy now. You can talk to him and stand where he can see you though. [I'm starting my exam]
Client: [keeps death grip on Fluffy, who looks very suspicious of the entire scenario]
Me: Actually I'm going to need you to let go of Fluffy for the moment, ok? I might startle him and he could lash out at you and you could get hurt. [I'm continuing my exam]
Client: Oh, Fluffy would NEVER do that! He loves me! [squeezes pet close to chest/face and grins, pet lifts lip and snarls]
Me: OK well I'm going to move Fluffy over for a moment so I can listen to his heart [put stethoscope on pet's chest, try to keep out of reach of teeth]
Client: Fluffy is SO GOOD [pats pet's chest rhythmically] oh and doctor I wanted to tell you this really important thing
Me: [stops ausculting] what? sorry, I was trying to listen to his heart. and please don't pat him while I'm doing this ok? It makes a lot of noise.
Client: oh, sorry doctor. [continues patting pet's chest]


Me: Well, I need to draw some blood. My nurse here will restrain Fluffy.
Client: Oh, I can do it [maintaining death grip and squeezing pet against chest]
Me: I'm sure you can, however I can't allow it. It's really safer for everyone if my nurse does it.
Client: But Fluffy will be scared if I'm not here! [maintains death grip]
Me: Actually lots of pets calm down when their anxious owner steps out, so if you want to leave that's fine, but you can stay too, I just need my nurse do the actual restraint.
Client: Don't wanna.
Me: Sorry?
Client: How dare you say I can't hold my own pet! It's an outrage!
Me: Well, you know, if Fluffy is surprised or hurt, he might bite, and if you get hurt-
Client: I don't mind if he hurts me!
Me: That's good to know, I mind if you get hurt, and also if he hurts you during this exam in my exam room, it's a big liability and I will be the one who did not reach the standard of care, which requires me to provide adequate restraint by a staff member in order to protect you from injury.
Client: well I would never sue you
Me: I'm sure you wouldn't, but I still need to reach the standard of care here....

and then either they laugh it off and agree with me and we go ahead, or they get really pissed and claim I am some horrible person who only cares about legal technicalities and not animals.

I just don't want to end up in the PLIT newsletter, here.


  1. Clients think the Pet ER is expensive now.....just wait till they tack on the extra fees for added liability. sigh.

  2. I'm so guilty of this - I follow directions, but usually I foolishly think I'm helping. Then while the tech and dr are working with my pup I'm like, Oh, duh, liability.
    Thanks to you and all vets for being patient when we're stupid and watching out for us!

  3. Have to say - I had a cat that would lunge through the bars of the cage to scratch and attack anyone who came near her at the vet office. But I could handle her. Until she bit me in a scenario you just described. I ended up on IV antibiotics. I felt sorry for the vet, and the cat and paid the bill.

  4. Guilty as well - with a capital G...I KNOW that the restraints that the techs use are tested and safe, but it "hurts" me to see my pet "stressed" by a restraining hold...

    There was a time when my 6 year old was the only one who could get his cat out of the carrier, onto the table, and examined. (this was the cat that adopted the kid the day that we brought the baby home from the hospital - wouldn't leave his side except to use the litter box or eat). We both objected when the tech suggested that the cat be sedated for the exam...Stubble removed the cat from the carrier, got said cat onto the table and held the cat's front quarters while the doctor examined and did shots.
    In my defense, I had no idea what kind of liability that the doctor was risking...I figured it was either "bite my kid" or "bite the tech" and I would have felt MUCH worse if the cat's victim was the tech rather than the kid that the cat slept with every night...

    oops. Sorry.

  5. I tend to use the "Fluffy may try to bite me and get your hand instead" line when they insist their pet would never bite them. My own cat bit me when I was holding it while my tech tried to shave a potty trail, and that was at home, without all the stress of a vet visit.

  6. I'll typically use the line that if my tech holds your pet he/she will be mad at us and when we're done he/she gets back to you where she's "safe"

  7. Yep, one reason not to let them hold: they might get bitten. Another reason: *I* might get bitten. I don't want to get sued, but I sure as hell cannot afford to lose my hands either.

    1. As a pet owner, I prefer to let professionals restrain my pet- for just the reason you describe. Unfortunately, the vet or tech doesn't always think that's a good idea and wants me to do it. Last week I had 2 cats at the vet. After placing the first cat on the table, I stepped back to let the tech do her thing. She asked me to step back up and restrain my cat, which I did without any problem. The other cat, a foster who I had not been to the vet with before, was up next. He was not nearly as calm as the first, and attempted to bite/scratch me. I was able to scruff and restrain the poor boy, and thankfully wasn't injured.

      Later, when we were getting ready to leave, they decided to weigh the unhappy foster again. I offered to accompany them, but they politely refused. Okay, no problem. A minute later the tech comes out to the waiting room and asks my friend or I to go back and help weigh the cat. My friend went, as I was taking care of the bill. Funnily enough, my friend had no problem handling the cat despite having met the cat that same day! I plan to use a different vet next time, one that is capable of weighing a cat without the owner's assistance.

  8. I have a cat from h*ll (but only at the vets) and I don't ever offer or want to help hold him. Because he WILL bite or class anyone in reach. Even after being drugged they handle him with leather gloves and a net like thing. This is after he actually got away from the vet tech and out of a muzzle a couple of times.

  9. I admit I've handled my dog (and my cat) at the vet, but most of the time, I was asked if I could or wanted to do it. The one time my cat injured me wasn't very serious, and they called in a tech to hold him the rest of the time.

    I have no problems letting techs hold my animals, though, as long as they aren't stressing him. Grabbing his leash, dragging him across the floor and pinning him to the ground with your body... I take issue with that. This is the same dog my current vet said was so good she'd never had a large dog (80 lbs) that she could examine by herself.

  10. I'm generally happy either way, as a patient. I did vet tech work in a shelter (yes I realize this is not the same as being an actual vet tech!) so I understand the holds and can generally help restrain my monsters. That said, I always offer, and if the bet declines I get the eff out of the way and stay in kitty's field of vision unless it antagonizes kitty, in which case I step out.

    The only time this didn't work was with a vet who for god only knows what reason wanted to take blood from kitty's jugular vein rather than his arm. He got out the clippers, cat went batshit, and we all got clawed and bitten. I suggested we might try the "wet his arm with alcohol and poke him in that vein" method, vet scoffed and went to clipper the foreleg.

    I did not return to said vet.

    1. The jugular is the preferred place to get blood in a cat because the size of the "arm vein" is small enough that it is very hard to get enough blood for a sample. Also, the time it takes for enough blood to flow out of the tiny vein can be enough time to have a clot form...and then the pressure used to draw out the blood sample can cause issue with the quality of the sample.

      So, many vets will choose to get blood from the jugular rather than the forearm.

    2. Ditto.

      Getting even 3 cc of blood from most cat's arms is an exercise in invariably clots due to the time involved. Cats platelets just love to clump & the longer it takes to get out an adequate sample the more likely clumping will occur.

    3. I would never use the front leg of a cat for blood draw. Usually jugular is best but for those frightened or fractious kitties I have fair success with a rear leg (medial saphenous)

    4. Thank you all for the input. I'm glad to know that the vet wasn't doing something as unusual as I had perceived. While I learned a lot working at the shelter, I fully realize I don't know everything about anything. :-) I'm usually the client who asks questions and wants to understand what's happening and why. I've now found a vet hospital whose vets across the board are communicative and respectful, and often invite me into the back to see ultrasounds and the like because they realize that I'm interested It's a good match.

  11. What really bugs me is the owner who, eventually, grudging lets you restrain their pet, but still insists on having some physical contact with it, and when you try to maneuver your body to block said contact, they rub or scratch YOU instead! It was one of my biggest pet peeves. Or they hold their fingers in front of their pets mouth and say "Mommy knows it hurts, here, you can bite mommy!"

  12. Then there are the clients that can't seem to stop speaking to the pet. Unfortunately they say the wrong thing, speak too fast and use a tone that stresses the pet further.

    When you are trying to calm your pet, calm yourself first. If you must say anything please speak slowly, in a calmer (usually lower) tone and say 'just relax'. These are words your pet won't be too familiar with and if you say them slowly and calmly it can help settle them.

    If you speak fast, in a high pitched voice your pet will get more upset as they don't understand the words but the speed and tone suggest danger to them.

  13. I too prefer jugular veins for feline phlebotomy. If I'm doing it in the room with a client, though, I'll typically use a medial saphenous with a 22 ga butterfly & let the vacutainers fill to draw.

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  15. $22K, eh? "Helping" the vet might become the new "Swoop & Squat" for the grifter with Fluffy in tow.

  16. "And you don't have to sedate my horse, he don't kick Doc...." its tough all over.

  17. I have a lot of love for the clients who come in and, before even putting the dog on the table, tell me I should muzzle him/her to be safe.
    Much less love for the MULTIPLE clients who bring in an unwell animal (often cats for some reason), and when I am up close and personal with Fluffy mid-exam, tell me that "I know he's sick because if he felt like himself he'd have taken a chunk out of you by now!"
    It doesn't matter how poorly and dull your pet is right now, if you know s/he is unpredictable and could bite or claw someone, tell me about the danger at the start so I can avoid it and keep you from getting damaged!

  18. I didn't know you could get cat muzzles! Are there rodent muzzles too?

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