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Issue: 61 - Jan 15, 2014
Veterinarians Treating Humans, Where Do We Draw The Line? ©
By: Charlotte A. Lacroix DVM, JD
Veterinary Business Advisors

Introduction

Patty Khuly, VMD, MBA of Veterinary Practice News recently wrote a very enlightening article regarding the high incidence of self-treatment and medication of all manner of maladies and injuries by veterinarians1.  She notes a 1988 study2 that found 77 percent of respondents to a survey reported self-treatment of injuries (most commonly involving sutures and antibiotics) while a 2000 study3 confirmed that high incidence. 

After all, why not, state proponents of self-treatment.  As veterinarians we have over 8 years of formal education, plus variable amounts of hands-on training regarding all sorts of medical issues, albeit in animals.  The differences between species are dismissed as minimal, with treatment based on common medical principles rather than intimate knowledge of human anatomy and physiology. 

However, treating yourself and treating another person is often considered an entirely different matter.  In treating yourself, you are accepting responsibility for your own actions; in treating others you open yourself to liability based on your actions.  This is often the cut off for many veterinarians; they are willing to risk treating themselves but not others because they know of the substantial risks that can be incurred.  In this article, the moral, legal, and ethical aspects of veterinarians treating humans are examined, with case examples highlighting how the ‘treatment line’ can vary greatly depending on the situation.

The Painful Truth

The unfortunate reality is that at work injuries in the veterinary field have the potential to become very serious, very quickly.  Most veterinarians, their staff, and even their family will be bitten, scratched, kicked, crushed, stuck with a needle or suffer from a host of orthopedic problems.  $8.3 million was claimed through the American Veterinary Association’s PLIT worker’s compensation program last year; and only about a quarter of American veterinary practices are part of this program!4  Take into account that there are about 22,000 practices nationwide and only about 6,000 are PLIT members, and the total cost of injuries in the veterinary practice could exceed $24 million. 

As anyone who has worked in a veterinary hospital might expect, bite and scratch wounds made up the vast majority (90%) of worker’s compensation claims submitted to Hub International Insurance between 2002 and 2004.4  Couple this with a 2006 injury prevention study that found 3 to 18% of all dog and 28 to 80% of all cat bites became infected, it is no wonder that cat scratch claims alone have an average loss of $802 per claim. 4  This increased to $1500 for dogs and $1200 for cats between 2006 and 2008.4  The worst part of all is that veterinarians who self-medicate with antibiotics have a higher complication rate than veterinarians who did not. 5

Though most of the statistics collected center on small-animal medicine, large-animal practitioners have their own problems.  Cows inflict the most veterinary injuries with 46.5 percent, followed by dogs with 24.2 percent and horses with 15.2 percent.2  Injuries from horse comprised only 0.3% of claim injuries, but average loss from those injuries was nearly $9,900.4  Despite this astounding figure, 24.5% of surveyed veterinarians chose to treat themselves when they suffered an injury while working with a horse. new6And for the older practitioners out there, more experience doesn't mean fewer injuries, either.  Thirty-one percent of injuries were reported by employees with less than one year of experience, but 42 percent were reported by workers with one to three years of experience.2

Not all workers' compensation claims from veterinary practices involve animals, but most do. While seventy percent of claims processed for PLIT members in 2006 were caused by exposure to or contact with animals, back and shoulder strains made up 8 percent of all claims and $1.5 million of the total workers' compensation tab, according to Hub International. 4  Those injuries frequently were caused by improper lifting and handling techniques, lack of lifting assistance and awkward postures.  More than 30 percent of veterinarians work with improper postures!5  And while veterinarians may not actively engage in massage therapy or chiropractic work to remedy such problems, easy access to veterinary muscle relaxants and other analgesics to ease the discomfort of ergonomic injuries makes the temptation to use them high.

Why Do We Do It?

Knowing that working that the veterinary field comes with all of the above risks means that veterinarians may be tempted to deal with these workplace injuries on their own.  Though no official study exists, research on the Veterinary Information Network’s message boards and the Society for Veterinary Medical Ethics listserv reveals many veterinarians admit to varying levels of practice on humans for a variety of reasons.

One of the most common excuses given for self-treatment or treatment of other is that it saves time.  Veterinarians are often are self-employed professions that feel that the demands of their case load outweigh their own personal health.  Others point to the fact that they are unable to a doctor’s appointment during a time when they themselves are not working (typically evenings or weekends).  Take for example, one veterinarian whose allergy to an outdoor plant had been previously worked up over the course of 3 weeks.  In the end, only doses of prednisone, a drug human doctors are much more loathe to prescribe than veterinarians, could bring down the swelling.  When this veterinarian came into contact with the plant again, her new doctor elected to start treatment again with “little gun” allergy medications, despite her insistence that only prednisone cured her condition; it was not until 10 days later, after the rash had spread similar to last time, the doctor relented and prescribed prednisone.  After a third exposure, the veterinarian chose not to visit a human hospital, instead prescribing a dose of prednisone to his/her own horse, taking it herself, and having the rash subside in less than 3 days. This example shows how timely treatment based on knowledge acquired by the veterinarian resulted in zero wait time in a hospital emergency room or doctor’s office and resolved the problem much quicker than if a human doctor had followed proper procedure.

Another of the major drivers behind the treatment of self and others is saving cost.  In these uncertain economic times, many practices and practitioners simply cannot afford to pay out of pocket for care or more in costly insurance premiums from increased claims.  Still others do not have the money to cover a replacement for an injured colleague or worker.  Factor in the fact that you or an employee may have to spend more than a few hours in a hospital’s emergency waiting room instead of treating paying clients animals and you have lost even more precious resources.  Other point out how filling a prescription at the local drug store often requires a co-pay plus charge for the drugs.  This cost is substantially more than taking the needed meds from the clinics stocks.  By treating themselves and others, veterinarians rationalize that they are saving valuable time and money than can instead be spent on the things they desire like working, spending time with family, or relaxing with friends.

Another major driver of veterinarians treating humans is over-confidence in one’s own veterinary education or mistrust of human doctor’s confidence.  As mentioned before, veterinarians undergo a rigorous training process and are constantly challenged to learn new and different methods of treating their patients.  The similarities between human and animal anatomy and physiology are vast, though veterinarians should know better than most medical professionals, what is good for one species can be toxic in another.  Take, for example, a human physician using acetaminophen to control pain in his/her cat; veterinarians know this drug can be very toxic to cats, despite its wide safety margin in humans.  Conversely, many veterinary practitioners do not know that consumption of Baytril can be toxic in humans while also causing hallucinations.

Current Regulations Regarding Treatment of Humans

This is despite every state’s VMA rules prohibiting the treatment or issuance of any pharmaceutical to any human; discipline is usually administered under a charge of unprofessional conduct.  Some states, such as Pennsylvania choose to specifically target ‘prescribing or administering drugs to humans’, by placing these regulations in Codes or Acts other than the State Veterinary Profession Act.6  Other jurisdictions tackle the issue in their State VMA Act by crafting a very narrow definition of what veterinarian on which veterinarians are allowed to practice medicine.  For example, the Kansas Veterinary Act states that veterinarians are only licensed to practice medicine on animals, defined as “any mammalian animal other than human and any fowl, bird, amphibian, fish or reptile, wild or domestic, living or dead.”7  Similarly, some jurisdictions, such as the Canadian province of Alberta, choose not to define “animal” in such detailed terms, instead adding the phrase “but does not include a human being” to their definition of animal.8  Others, like Texas9 and Tennessee10 specifically state that a veterinarian “shall not provide care and treatment of humans including the dispensing prescription medication for personal use by a human”.  And finally, the states of Texas9 and Kansas7 go even further with provisions of when a veterinarian may practice medicine on a human without fear of liability.  Their acts state “a veterinarian may render first aid or emergency care to a human if such action is without expectation of compensation in response to an emergency or disaster situation.”  This will be further discussed in a case example.

Conclusion

At the end of the day, veterinarians must be reminded that practicing medicine on humans is not permitted, unless under extenuating circumstances.  If a veterinarian does choose to treat a human patient, whether themselves or a family member or employee, they must weigh the risks and benefits of not only getting caught performing such acts, but the liabilities associated with treatment. 

The general consensus on veterinary message boards seems to be that “simple” procedures, such as using first-line antibiotics for various infections up to suturing a small cut, are acceptable, given they appear to have a relatively low risk to the one being treated.  However, the potential for license revocation and reprimand should the case take a turn for the worse still remain a large and looming shadow.  There also seems to be a ‘line in the sand’ at treating others; veterinarians recognize that if they treat themselves, they are assuming the risks associated and are often comfortable with this risk.  They are not comfortable, however, with having another person assume this risk.  For some, this is especially true with treating family members, especially children.  Regardless of where your own comfort level may be, there is always the risk of being punished for practicing outside your scope.

Bottom line: just as we expect other health care professionals to respect our scope of practice, we must also respect theirs.  Is the convenience of treatment worth the potential cost?

Veterinary Business Advisors, Inc.

www.veterinarybusinessadvisors.com

References:

  1. Patty Khuly. Veterinarian, Treat Thyself. Veterinary Practice News. http://www.veterinarypracticenews.com/vet-practice-news-columns/reality-check/veterinarians-treat-self.aspx
  2. Landercasper, J., Cogbill, T.H., Strutt, P.J., Landercasper, B.O. (1988). Trauma and the veterinarian. The Journal of Trauma and Acute Care Surgery28(8), 1255-1259.
  3. Jeyaretnam, J., & Jones, H. (2000). Physical, chemical and biological hazards in veterinary practice. Australian veterinary journal78(11), 751-758.
  4. Racheal Whitcomb. The Price of Pain. DVM 360. http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=666581
  5. Ambroz, K. G., Moy, R. K., & Chan, S. B. (2008). 251: Complications of Self-Treated Bite Injuries Among Veterinarians. Annals of Emergency Medicine,51(4), 547-547.
  6. Lucas, M., Day, L., & Fritschi, L. (2009). Injuries to Australian veterinarians working with horses. Veterinary record164(7), 207-209.
  7. Gabel, C. L., & Gerberich, S. G. (2002). Risk factors for injury among veterinarians. Epidemiology13(1), 80-86.
  8. Controlled Substances, Drugs, Device, and Cosmetic Act of the State of Pennsylvania, Section 11(e). Professional Prescription, Administration, and Dispensing. http://www.health.state.pa.us/pdf/ddc/ddcAct.pdf
  9. Kansas Veterinary Practice Act, Section 47-816(a). Definitions. and Section 47-841(b) Veterinarian not liable for good faith volunteer actions. http://www.kansas.gov/veterinary/KS_Practice_Act2.pdf
  10. Alberta Veterinary Profession Act, Section 1(a). Definitions. http://www.qp.alberta.ca/documents/Acts/V02.pdf
  11. Kansas Board of Veterinary Examiners v. Carder,
  12. Kansas State Board of Healing Arts v. Carder,
  13. Rollin, B. E. (2003). An ethicist's commentary on when a veterinarian can render medical assistance to people. The Canadian Veterinary Journal44(3), 189.