Coping with Board Complaints

During the pandemic, clients are increasingly filing complaints with state veterinary boards against veterinarians. This article explores ways to protect both your license and your mental health, including documentation, veterinary license defense, and wellness resources.

Ashleigh_and_Morgan-Courtesy_of_New_Frontier_Animal_Medical_Center.jpg

Protecting Your License—and Yourself

by Jen Reeder

THE WOMAN WITH THE BULLDOG SUPPOSEDLY WANTED A “SECOND OPINION” when she arrived at AAHA-accredited New Frontier Animal Medical Center in Sierra Vista, Arizona. The dog had been diagnosed by a board-certified internal medicine specialist with a nasopharyngeal mass, which was severely obstructing the dog’s breathing.

Jenn_and_Morgan-Courtesy_of_New_Frontier_Animal_Medical_Center.jpgThe dog passed out four times while Pam Drake, DVM, met with the woman, who told the veterinarian of 35 years that she wanted the mass surgically removed—from what Drake explained was an inoperable area. The client confessed she’d been up all night holding her dog’s chin up because he’d pass out any time it dropped, and that in addition, she couldn’t afford radiation.

Ultimately, she opted for euthanasia, then sent an angry email two days later that read, “I brought my dog to you for surgery, and you put him to sleep. That wasn’t what I wanted.”

“I knew the handwriting was on the wall, and it was going to be problematic,” Drake said.

Sure enough, the following week, Drake received a letter from the state veterinary board. The client had filed a complaint against both Drake and the internal medicine veterinarian whom she originally consulted.

Every state veterinary board operates differently, but in Arizona, virtually every complaint goes to an investigative committee, Drake learned. She had to submit all her paperwork and write an account of what happened. The technician who was present for the end-of-life discussion and euthanasia also submitted an affidavit. The process took several months and was capped by a phone interview with the investigative committee. The board ruled she’d done nothing wrong. “What helped me get through this was that my staff was superb at documenting every conversation we had with her,” she said. “And our practice has very well-written paperwork that she had signed saying she was electing euthanasia and giving me permission to do it. So it was a matter of all the i’s being dotted and t’s being crossed.”

Still, the experience was extremely upsetting.

“The emotional toll that it takes is very real because here you are in this situation. This dog is obviously suffering. You’re trying to help this person through a difficult time. And then that’s the backlash you get,” she said. “It really feels like a betrayal and makes you very cautious about dealing with people.”

Complaints on the Rise

Sharon-Courtesy_of_New_Frontier_Animal_Medical_Center.jpgWhen a client files a false report or even a valid claim with a state veterinary board, it can be stressful, time-consuming, and potentially expensive—and during the pandemic, complaints have been spiking. So it’s important to take steps now to protect both your license and mental health should the situation arise.

Drake said it’s helpful to keep in mind that state veterinary boards typically aim to be educational rather than punitive. She found the board members to be professional and compassionate throughout the process.

Mark McConnell, BVMS, MRCVS, chief medical officer of Lakefield Veterinary Group, former AAHA president, and former chair of the Oregon Veterinary Medical Examining Board, said he served on his state’s veterinary board for about a decade as a way to give back to the profession. He feels the “vast majority” of state boards want to be of help to veterinary professionals while offering consumer protection.

“If you are following AAHA standards and if you are providing excellent, impeccable medical records, that is often your best defense,” he said.

When medical records are clear, complete, well documented, and legible and tell a story that makes sense, the board tends to believe the documentation, according to McConnell.

He noted that board complaints must fall under the provision of a state’s Veterinary Practice Act, which don’t typically regulate business practices such as hours of operation or fees.

“There may be a client upset about the money. And when they realize that the practice act doesn’t address finances, then they may look at the medicine,” he advised. “So that’s another reason why your medical records need to be impeccable.”

Michelle Cave, a spokesperson for the California Department of Consumer Affairs, which oversees the Veterinary Medical Board, agreed that detailed records are the most important piece of evidence. In fact, if the records are inadequate, that itself could be cause for discipline, but it may not lead to a license being suspended or revoked, she noted.

“We want to make sure that you’re still able to keep your livelihood and do what you love, but here are the guidelines according to statute, and you have to follow these,” she said. “If it’s evident that the individual is a repeat offender of the same thing, then that’s when the board has to bring down the hammer and be more punitive.”

She said all complaints are thoroughly investigated, and about 90% do not result in disciplinary action or citation.

The board typically receives around 1,300 complaints per year, mainly from pet owners, but again, that has jumped during the pandemic. At the end of the fiscal year 2020/2021, the board had received 25% more complaints over the prior fiscal year, according to Cave.

Positive Culture and Self-Care

Beth Armstrong, CVT, RVT, CFE, CCFP, and former AAHA practice consultant, said a strong, empathetic practice culture can help a member of the team through the stress of being reported to a state veterinary board. “Just because your doctor has been reported doesn’t mean there is something wrong with your doctor,” she said. “So being supportive to your doctor during that moment—or to anyone during that moment—is really important, because it’s really hard to deal with that.” Self-care should start before an accusation since it can be so challenging to start new habits during a particularly stressful time, according to Donna Hamilton, MD, MS, a former board-certified pediatrician and now a trauma-informed wellbeing strategist and CEO of Manifest Excellence.

“I’m a big fan of being proactive and preventive care,” she said. “This would be a phenomenal time to being to think about what your self-care and stress management practices are.”

Veterinary License Defense:
What You Need to Know

One simple way to protect yourself and your livelihood is an insurance coverage called veterinary license defense (VLD). If a claim is filed against your veterinary license with the state veterinary board, your insurance carrier assigns a defense attorney—well-versed in your state’s veterinary practice act and board investigations—to help guide you through the process.

It’s more affordable than you may think. For instance, the AVMA’s Professional Liability Insurance Trust (PLIT) program offers an endorsement for veterinary license defense with three options, including up to a $100,000 defense limit with an annual premium of just $135/year.

Linda Ellis, DVM, Director of Trust Veterinarians for the AVMA Trust, said VLD is a small price to pay for peace

of mind, particularly since board complaints are increasingly common owing to the public’s awareness of state licensing boards, the internet, social media, and, now, the pandemic.

“It is extremely easy for a client to make a board complaint,” she said. “All they have to do is call the state board, send a letter, or go online and fill out a form. It takes 15 minutes of their time, and it’s going to really affect that veterinarian for 1 to 2 years, or possibly longer. That’s why we highly recommend every veterinarian have VLD to protect themselves and protect their license.”

She noted that it’s important to enroll in coverage before a license complaint is ever made, as the coverage must be in place on the date of the incident the client is complaining about in order to respond.

For more information, visit: avmaplit.com/vld.

While people might hear the term “self-care” and think of pampering or meditation, it can also involve eating well, exercising, laughing, cleaning up household clutter, and going to the doctor.

“When you’re faced with a major stressor, it’s common to begin to feel a little bit ill or sick or have physical ailments,” she said. “So, if you at least know that you’ve had your well checks, then it’s easier to perhaps compartmentalize.”

She recommends finding and seeing a therapist or other mental health professional before a crisis arises—even just a time or two—to have a relationship in place when faced with mounting challenges. People who have experienced childhood abuse or other traumas should pay particular attention to self-care, since the stress of feeling attacked can heighten the nervous system response, she emphasized.

One daily wellness tool is doing a “brain purge” before bed: write down your mental to-do list and then forget about it so you can relax into sleep. In that same vein, journaling can help. Try writing down thoughts and concerns in a notebook or on a sheet of loose-leaf paper that you then tear up to dodge the sometimes unwanted pressure of preserving unhappy thoughts.

Melanie Goble, DVM, owner of Renewed Strength Veterinary Services in Manitowoc, Wisconsin, and treasurer of Not One More Vet (NOMV), a veterinary peer-to-peer support group, said when someone files a formal report or complains online or at the clinic veterinarians should think about their last 100 cases.

“If one went wrong out of 100 cases, that is still a 99% success rate,” she said. “Most of the day, all our things go right, but we let that one thing really bog us down. As individuals, we have to learn to deal with our perfectionism.”

Though she’s quick to note NOMV doesn’t promote toxic positivity, she said it can help to end each day by thinking about three good things that happened. Instead of overarching concepts like “I have my health,” focus on specific instances like “I got a really good parking spot at the store” or “My kids didn’t fight today.”

Since it can be easy for clients to be mean—though Goble’s never had a complaint filed with a state board, she’s had clients threaten physical violence, and one cruel man told her she should kill herself—she suggests practices celebrate client kindness on social media to model good behavior.

weston_birds-Courtesy_of_New_Frontier_Animal_Medical_Center.jpg“For your clinic Facebook pages, try putting up things like, ‘Shout out to Fluffy’s mom, who dropped off a thank-you card and flowers,’ or ‘We had a really stressful day today with a lot of really tragic cases, but Tigger’s mom brought us a plate of brownies and it brought a bright spot to an otherwise horrible day.’ That’s how we show people to be nice,” she said. “People can’t be mean if they’re giving a heartfelt gift.”

On the veterinary side, Goble said it’s imperative to practice “CYA medicine” in today’s litigious society. “My first recommendation is to actually read your state practice act and know what it says,” she said.

Goble is a relief veterinarian licensed in five states, so she keeps extremely detailed notes and always follows the most stringent rules to the letter of the law.

For instance, in Wisconsin, veterinarians are required to offer clients every possible treatment option—including doing nothing. So, if a dog has a broken leg, she’ll explain possible treatments and add, “I have to tell you, you have the option of doing nothing. That is neglect, but you have that option.”

When a client becomes upset or angry, she recommends saying something like, “Let’s stop for a minute and talk about this in X number of days,” if it’s something that can wait. Then try mediation; many professionals offer it specifically for veterinary clinics. NOMV also has a volunteer mediator who can help.

If the conflict does culminate with a client filing a report with the state veterinary board, don’t be afraid to reach out for support, Goble emphasized.

“When we’re in the middle of the badness, it’s okay to come to NOMV and say, ‘Hey, I need a shoulder to lean on. I need a support structure because I can’t stand up on my own,’” she said. “And we’ll be there. That’s a promise we can always make. You are not alone.”

 

Roxanne Hawn
Award-winning journalist Jen Reeder is incredibly grateful to the veterinary teams across the country who work so hard to help people and pets in their communities.

 

Photo credits: Ashleigh and Morgan, photo courtesy of New Frontier Animal Medical Center, Jenn and Morgan, photo courtesy of New Frontier Animal Medical Center, Sharon, photo courtesy of New Frontier Animal Medical Center, Leslie, photo courtesy of New Frontier Animal Medical Center, Photo courtesy of New Frontier Animal Medical Center.

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