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  News from the Maryland Veterinary Medical Association                                                   Summer 2012

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Why Veterinarians Should Use Written Consents and Written Estimates
by David Handel, DVM

The Maryland State Board of Veterinary Medical Examiners (SBVME) meets monthly and hears cases against veterinarians licensed to practice in the state. In addition to this highly important task, the SBVME’s members spend time trying to understand and mold state laws as they apply to the practice of veterinary medicine. Many cases brought to the SBVME could have been prevented through better communication between the veterinarian and the client. Often, clients feel that they did not understand the services that were to be performed, and the costs for those services. As a result, the SBVME is considering introducing a regulation that would require veterinarians who practice in Maryland to obtain written consent and provide treatment plan estimates for surgical or anesthetic procedures and hospitalization.

While a new concept for the state of Maryland, many other state boards have already embraced this framework, which protects both veterinarians and clients. Veterinarians who obtain written consent for certain procedures know that their clients are aware of what is going to be done with their pet. Clients who sign a consent form also know what the veterinarian intends to do, and they should have an opportunity to ask questions, if they have them, when presented with a consent form. Several states, including Idaho, Missouri and Minnesota, already have laws or regulations on the books addressing this concept of informed consent.

In Idaho the law states that consent forms “signed by the patient’s owner or other legal caretaker for each surgical or anesthesia procedure requiring hospitalization or euthanasia shall be obtained, except in emergency situations.” The law in Idaho goes on to say that these consents must be part of the medical record and be kept by the veterinarian.

Similarly, Missouri requires written consent “prior to placing any patient under anesthesia or performing any surgical procedure.” As in Idaho, emergency procedures undertaken in Missouri are exempt, as the time taken to obtain consent may not be practical.

According to the May 1, 2012 issue of Veterinary Practice News, the State of Illinois is currently considering a bill that would require consent from an owner for any services over $250. This bill was prompted by a disgruntled client who felt she was not adequately apprised of the charges for which she was responsible after what she thought was a routine veterinary visit.

As the basis for the regulation to be introduced in Maryland, the SBVME looked to the AVMA’s model practice act. The model practice act suggests that members of the public will be happiest when they have information about procedures being performed on their pets, as well as knowledge of the fees associated with those procedures. The AVMA states that veterinarians should inform owners of “the diagnostic and treatment options available. They should also provide an assessment of the risks and benefits . . . a prognosis, and a documented estimate of the fees expected for the provision of services.” They go on to note that this information would be provided in either written or verbal form and maintained in the medical record.

James F. Wilson, DVM, JD, who teaches Iowa State University’s veterinary law course, reminds us that “consent forms are evidentiary documents that serve to prove that clients agreed to professional services after having been informed of proposed medical or surgical procedures, their risks, and probable outcomes.” He goes on to remind us that “nothing can provide guaranteed protection against lawsuits,” but written consent can certainly assist veterinarians “toward a solid legal defense.”

While taking the time to prepare and explain a written consent form to a client may seem onerous to those unfamiliar with doing so, written consents are key for several reasons; they serve to: educate our clientele; assist veterinarians in formulating a treatment plan; help owners understand costs associated with services; and help minimize misunderstandings of services to be provided and minimize the filing of future complaints. Consents with estimates also help owners deal with the cost of care prior to the services being performed. If your initial plan is not within your clients’ means, consents with estimates will allow opportunities for additional discussions about alternatives.

One simple example of how a written consent and estimate would assist a veterinarian in every day practice is a routine dental procedure. If Fluffy comes in for a routine dental procedure, her owner, Mrs. Smith, should understand the peri-operative care to be provided, including lab work, and IV catheterization, anesthesia, and the risks of the procedure, as well as an understanding of recovery and post-operative care. She should also understand the costs associated with each of these items. If Mrs. Smith signs the consent form and estimate when she returns to pick up Fluffy, she will understand that she will be charged for each of these items and there should be few, if any, surprises. You may wish to include both a “high” and “low” estimate. The “low estimate” might be a dental procedure that requires no tooth extractions. Your “high estimate” may include prices for extractions, dental x-rays, and associated care. Again, if Mrs. Smith knows the cost of an extraction and you advise her that an extraction was done, she will not be surprised that there was an additional cost. The consent and estimate will help both your practice and your clients.

If you are not currently obtaining written consent or offering written estimates to your clients, you may wish to take some time now to consider how you can do this prior to the SBVME’s adoption of a regulation. You might begin by networking with your colleagues. Ask them if they are already obtaining written consent or offering written estimates to their clients and, if they are, how they are doing this. You may also find Dr. Wilson’s book, “Legal Consents for Veterinary Practices,” to be beneficial, as it contains many templates for practice use. Many software packages also provide templates for consent and estimates.

The SBVME will advise all veterinarians licensed in the state of Maryland if and when a regulation is adopted. Sample consent forms will be provided by the SBVME that may be tailored for your use. Please send any comments or suggestions regarding this proposed regulation by October 29, 2012, to Laura Downes, Executive Director, at State Board of Veterinary Medical Examiners, 50 Harry S Truman Parkway, Room 102, Annapolis, MD 21401, or fax to 410.841.5780.  

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