THE BUSINESS OF PRACTICE


later and results in bad feelings with the owner when they eventually learn the truth. In our hospital, we take a photograph of every


horse both when it arrives and when it is discharged from the hospital. Any lesions or cuts that may be present are photographed. These photographs are date- and time-stamped and are added to the medi- cal record. Digital photography is increasingly ac- cessible with the advent of camera phones. It is relatively inexpensive as well. Photographing le- sions and problems allows for objective evaluation of the progress of a case without relying on subjective memories, and the images are easily shared with owners who may not be the animal’s primary caretaker. We weigh each horse on admission and discharge.


This allows for more accurate drug dosing and pro- tects the hospital from owner complaints about lost weight while the horse was hospitalized. We use a digital scale, although a weight tape and calculation can be used. Additionally, body score and condition is noted on the admission physical examination. With business and case communications being in- creasingly conducted through text messaging, text messages are becoming part of the legal and/or case record. There are several ways to print text mes- sages with the dates, sender, and recipient recorded in the printout. Such methods include specific soft- ware programs that transfer data from a phone, to forwarding messages to an e-mail, or even taking photographs of the text messages. Phone calls are summarized in the records and are often followed up with an e-mail stating “to reiterate our conversation of such date and time…” followed by a synopsis of the conversation, which is also printed and added to the medical record. This practice is also beneficial in that it gives the client the opportunity to better understand what was discussed during the conver- sation and for disputing the validity of the conversation. On occasion, communications by phone, text, or


fax are disputed by the client. When a document is faxed to a client, we record the date and time the item was faxed. We also keep a binder with the printed logs from our fax machine showing all in- coming and outgoing faxes. This prevented, in one case, a judgment being vacated because the client claimed we never faxed a letter to them. We were able to prove, in a matter if moments, that we, in fact, did fax the client and that the fax was received. In addition, phone bills can be used to prove a phone call or text message was made or received, although the content of the message cannot be proven. Communications through the United States


Postal Service are also often disputed by our clien- tele in legal cases. When important documents are mailed by United States Post Office First-Class Ser- vice, you can ask for a certificate of first-class mail- ing. This is simply a receipt with the recipient’s name and address and the date that it was mailed. This costs less than a dollar and is significantly less


284 2013  Vol. 59  AAEP PROCEEDINGS


expensive than sending certified mail. It is legal proof of mailing, although obviously it does not prove content. In the rare instance that proof of content is required, we have our office staff mail the document and then write a sworn statement stating the content of the mailed document. This state- ment is then notarized. In some instances, owners will make complaints


to the state board or file for malpractice when they are compelled to pay a bill. Often, they threaten to do so first; therefore these cases are not a surprise. At this time, you must decide if the benefit of bill collection is worth the time defending yourself to a court or state board. We always pursue payment in these cases. Although this may not always be a good financial decision, it is our business policy be- cause we believe that it is important to defend our reputation and support any associate veterinarians who are named in the complaint. It is important to know all the individual state


laws and rules governing the practice of veterinary medicine. There are variations in laws even in neighboring states. For example, in Massachu- setts, an owner must give informed written and witnessed consent before tranquilization of any an- imal. Therefore, before you sedate a horse for a dental or other procedure, you must have the owner sign a consent form and have it witnessed. A signed invoice after a procedure or the fact that the owner gave verbal consent and held the horse for the tranquilizer injection is not sufficient. They can still claim they did not give prior consent. This is different from the laws in neighboring New York State. In today’s world, social media outlets such as Fa-


cebook and list servers are becoming more and more prevalent. Remember: Anything that you put on the Internet can always come back to haunt you. Nothing should be written that cannot be viewed by clients or defended in court, even on a personal Facebook page. A list server recently featured a thread regarding the necessity of wearing sterile gloves for castrations. Several veterinarians com- mented that this practice was not necessary and was an unnecessary expense. Individual veterinarians may agree or disagree with this statement, and it should be noted that a percentage of castrations will become infected despite precautions. Additionally, owners and/or trainers should be told both in verbal and written form of the possibility of complications from castration, including infection, with each pro- cedure. It would be counterproductive to a defense if an owner brought you to court for an infected castration and could provide written documentation that you did not wear gloves because of the expense. With owner ability to research on the Internet, the


idea of regional standard of care is becoming less prevalent to almost nonexistent. It is difficult to support a claim that you had no knowledge or un- derstanding of a treatment being performed on the other side of the country. Internet searches and


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