March 15, 2010

Veterinary Vaccine Disclosure: There Ought to Be a Law

Reading an article authored by a veterinarian cum lawyer about the veterinary Liability Related to Informed Consent, maybe I'm missing the point, but what liability? There ought to be a law compelling veterinary vaccine disclosure to get informed consent before routine shots or treatment. There is none.

No federal law requires a veterinarian to inform a dog or cat owner of the risks versus benefits of any drug used in veterinary practice. Animal vaccines are regulated by the USDA; there is no "off label" use. A veterinarian may use any vaccine for anything at any time.

At a glance, a few states including New York, Wisconsin and Texas have laws on the books that suggest that licensed veterinarians discuss the possible bad outcomes of drugs used in their patient care.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as Rimadyl and anti-fungal medication such as Ketaconazole have not been tested or approved for use in animals. They are good drugs with bad side effects. To use them without first discussing the potential for kidney and liver damage ought to be a crime, it's not.

According to Christie Keith, in her article "What the FDA Wants Your Vet to Tell You," the FDA has requested that veterinarians provide information to clients on FDA-approved drugs prescribed to companion animals. No one is keeping them honest, but themselves. 

Veterinarians are loosely bound to principles established by the American Veterinary Medical Association (AVMA) which suggest that its members inform clients of the risks versus benefits of drugs used on companion animals.  Abiding by this code is voluntary, an ethical responsibility.

So if a veterinarian gives Rimadyl to a senior dog for the painful symptoms of arthritis without first telling its owner that this drug has been implicated in many old dog deaths, and my old dog becomes one of them, oops, it's a character flaw, not a legal liability.

As in the case of many professions that are self policed rather than regulated, without consequences, giving dog and cat owners the information we need to protect our pets from vaccine use and abuse simply does not occur. 

In 1996, the Food and Drug Administration formed the Center for Veterinary Medicine established the hotline, (888) FDA-VETS, to receive calls from veterinarians about adverse experiences to approved animal drugs. A two-year review showed that most of the calls came from pet owners who found the link on the Internet.

They reported that they did not receive a client information sheet for a drug prescribed for their pet when one was available. The medication purchased from the veterinarian was not dispensed in the CVM-approved packaging and was not accompanied by a client information sheet or approved label. The veterinarian did not conduct or recommend blood testing before and after prescribing the drug, even though baseline testing and/or periodic monitoring was recommended on the label.

As a result, pet owners learn after the fact - and often the hard way - that a precaution or contraindication exists for their animal companion.

Oh sure, pet owners have legal recourse; we can always sue. Indeed, some pet owners have received substantial jury awards for the role of veterinarians in the loss of cherished companion animals.

In 2004 a jury in Orange County, California, awarded a dog owner $39,000 in a veterinary malpractice suit acknowledging the “special value” of a $10 mixed breed dog that died after $20,000 in veterinary services.

These cases are the exception. In most states, monetary awards for cases involving family pets are limited to their "market value" and malpractice is difficult to prove.

As with malpractice cases involving people, no presumption or inference of negligence arises merely because the medical treatment culminates in a bad result. Just because Fluffy or Spot dies after its rabies booster shot does not mean the shot was the cause. An adverse reaction to medication may have many possible causes. 

Nor is a veterinarian negligent in administering to a sick or senior pet a drug intended for use in healthy animals.

Veterinarians are also bound by state professional boards to abide by state laws governing the administration of vaccines in both food producing and non food producing animals. So if your sweet, little Maltese - who is subject to seizures - suffers and dies from an adverse reaction post mandatory rabies booster shot, tough noogies. The shot was mandated by law.

Maybe I'm just splitting the semantical hair.

"Informed consent" is a legal term. It relates to professional negligence and establishes a breach of the duty of care owed to the patient. It is based on the idea that every competent human being has a right to determine what is done with his or her own body, or in this case, to the body of the family pet. It holds a physician accountable for explaining - in plain language - what might occur as an unintended consequence of a medical procedure or medicine. It implies some liability when they do not.

When the strongest push to be forthcoming is a suggestion, veterinary ethics about informed consent are more like Pirates of the Caribbean: "the code is more what you'd call 'guidelines' than actual rules." 


References:

For the rules of each state see the map of the United States with each state’s regulations regarding veterinary practices. http://animallaw.info/articles/armpusstatevetlaws.htm.

The Principles of Veterinary Medical Ethics of the American Veterinary Medical Association.  http://www.avma.org/issues/policy/ethics.asp

To research drug side effects: http://www.drugwatch.com/side-effects/

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