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Consultant's Corner: Anesthetic Deaths

by Christine Hotz, DVM
Board Consultant

Many of the complaints against veterinarians received by the VMB cross my desk at some point in the complaint review cycle. An all-too-common theme I see is that of an angry or grieving pet owner who believes his or her pet died as a result of negligence during the anesthetic period. As a consequence of this unfortunate event, the veterinary client often enlists the help of the VMB to investigate the cause of death.

One of the first steps of the investigation process is to request the responding veterinarian to submit a copy of the patient's medical records and a narrative of the events surrounding the death. We receive responses that range from lengthy narratives accompanied be sworn statements from involved staff members and supporting documents from medical texts, to responses that are simply a copy of one line of the medical record entry stating the date and phrase "OVH--DIED." One of the challenges that face the staff, consultant, and complaint review committee members is determining when a patient death was indeed due to negligence on the part of the veterinarian. The extremely abbreviated responses we receive do little to reassure us that the veterinarian performing the procedure was competent and that he or she provided a level of anesthetic monitoring that falls within the minimum acceptable standard of practice.

There is nothing like an anesthetic death to challenge the sometimes tenuous veterinarian-client relationship. Obtaining the informed consent of the pet owner prior to the anesthetic and/or surgical procedure may be one of the most important steps in establishing an understanding with the client. This process addresses the issue of risks associated with the procedure. Discussing these risks may prompt a client to volunteer patient history information, such as the presence of a preexisting disease or recent ingestion of food, that may be significant with regard to anesthesia. Additionally, the client has the opportunity to ask specific questions, and the veterinarian has the opportunity to request permission for precautionary measures, such as preanesthetic blood work.

Everyone will agree that an anesthetic death can happen in any practice, and that it is frequently not a result of veterinary negligence. The task of the veterinary practitioner is to develop and document policies and procedures that minimize the likelihood of an anesthetic death. Common sense alone would appear to indicate the need to examine an animal prior to the administration of general anesthesia. However, in California, the Veterinary Practice Act contains a code section that mandates this practice. Title 16 of the California Code of Regulations, Section 2032(b)(1)--Anesthesia states "Within twelve (12) hours of surgery, every animal will be given a preanesthetic examination."

If details of the presurgical examination are not recorded in the medical record, a veterinarian may be given the difficult task of proving to our reviewers or investigators that an appropriate examination was, in fact, conducted within the prescribed time frame. Developing the habit of recording these important findings in your medical record could save you a great deal of grief later.

Many progressive practices have instituted measures to improve the level of anesthetic safety. They use registered veterinary technicians to monitor the entire anesthetic period, and anesthetic monitoring devices such as pulse oximeters, blood pressure monitors, and oscilloscopes as additional aids. However, the use of these devices is rarely recorded on the medical records we review. Likewise, it is the exception, rather than the rule, to see documentation that an endotracheal tube was used during a procedure. If recording all of this information in the medical record seems too arduous a task, you might consider designing an anesthetic form that allows you to record much of this information with a check mark.

No amount of medical recordkeeping takes the place of conscientious monitoring of a patient under anesthesia. It is our duty as professionals to stay abreast of the advances made in the field of veterinary anesthesia, and to become familiar with new agents and monitoring equipment before we use them on our patients. Perhaps the best way to avoid unnecessary anesthetic death is to respect anesthesia for the miracle it truly is.