PPE malpractice

[anony2]

Posting under an alter. Has anyone ever sued for PPE malpractice?

Long story short, I asked for spine radiographs to check for kissing spine in Oct 2017. Horse palpated sore in middle back at that time. Back was “clear.” Fast forward to last week and horse had a ppe done for a buyer buying from me. Horse palpated sore in middle back. They took a radiograph and there is clear, advanced kissing spine involving 5 vertebrae. The rads I have are of behind the withers and at the end of the back, no radiograph was done of the middle back where the issue is. When I talked to the vet that did the PPE in Oct, he stated that that is where he “usually sees” kissing spine.

I asked for a full back series.

I talk to an atty Friday, but wanted to hear others’ experiences if possible.

[S1969]

@anony2

The rads I have are of behind the withers and at the end of the back, no radiograph was done of the middle back where the issue is. When I talked to the vet that did the PPE in Oct, he stated that that is where he “usually sees” kissing spine.

No, I have never sued.

I would guess this is a buyer beware situation - if you did not question the fact that the entire back wasn’t xrayed at the time, I’m not sure what recourse you have now.

I am assuming the vet was not your regular vet? I have never had a vet other than my own vet do the PPE, so I don’t know the typical procedure. I would think that if I bought a horse at a distance I would have my own vet review the rads since I am not an expert.

Curious what others will say.

[Guilherme]

In a professional negligence case the plaintiff must prove that:

There was a duty of care owed.

That the duty was breached.

And that a loss that occurred was result of the breach of duty.*

These are not easy cases to win. If in the OPs case they have x-rays showing a condition that was not properly diagnosed and they can get an expert to say that the films are clear enough that a reasonably competent vet. would have seen and reported on them" then they have a shot.

G.

*Causation has two elements: cause in fact and proximate cause. The first element is self explanatory. The second is more difficult to explain. Sometimes it is couched in terms of “foreseability.” I think it’s easier to think of it in negative terms. The question in that form is “while cause in fact is clear is there a reason or set of reasons to not hold the defendant liable, such as fairness, public policy, etc.?”

[anony2]

@Guilherme

In a professional negligence case the plaintiff must prove that:

There was a duty of care owed.

That the duty was breached.

And that a loss that occurred was result of the breach of duty.*

These are not easy cases to win. If in the OPs case they have x-rays showing a condition that was not properly diagnosed and they can get an expert to say that the films are clear enough that a reasonably competent vet. would have seen and reported on them" then they have a shot.

G.

*Causation has two elements: cause in fact and proximate cause. The first element is self explanatory. The second is more difficult to explain. Sometimes it is couched in terms of “foreseability.” I think it’s easier to think of it in negative terms. The question in that form is “while cause in fact is clear is there a reason or set of reasons to not hold the defendant liable, such as fairness, public policy, etc.?”

1. I contracted with the vet to perform a PPE and check the horse for kissing spines (specifically asked about this deformation) and asked for a full series of back xrays
2. Only a portion of the back was xrayed
3. The portion that wasn’t has significant kissing spine with arthritic changes that don’t occur in a matter of 6 months
4. I am not an expert that could possibly know if the entire spine was xrayed or not.

[Denali6298]

@anony2

1. I contracted with the vet to perform a PPE and check the horse for kissing spines (specifically asked about this deformation) and asked for a full series of back xrays
2. Only a portion of the back was xrayed
3. The portion that wasn’t has significant kissing spine with arthritic changes that don’t occur in a matter of 6 months
4. I am not an expert that could possibly know if the entire spine was xrayed or not.

Usually, when I am not using my regular vet for the PPE for whatever reason, I send the X-rays to them to look at. Also, I am always present for the PPE so that I can watch and make sure everything I want was done. You maybe SOL.

[anony2]

@Denali6298

Usually, when I am not using my regular vet for the PPE for whatever reason, I send the X-rays to them to look at. Also, I am always present for the PPE so that I can watch and make sure everything I want was done. You maybe SOL.

I was present, but was not allowed in the xray room per their practice rules.

[Denali6298]

@anony2

I was present, but was not allowed in the xray room per their practice rules.

Did you have them show you and explain the x-rays?

[anony2]

@Denali6298

Did you have them show you and explain the x-rays?

I was told that there was a thoracic and lumbar spine radiograph and that the horse’s spine was within normal limits and that no kissing spine was present. Literally I was so confident I had spinal xrays that I told the prospective buyer that I had done xrays of his spine ahead of time and that I was happy to share. The buyer’s ppe vet was the one who told me I was missing a portion.

[Denali6298]

Ouch. That may be a buyer beware issue. I wish you luck.

[Guilherme]

@anony2

1. I contracted with the vet to perform a PPE and check the horse for kissing spines (specifically asked about this deformation) and asked for a full series of back xrays
2. Only a portion of the back was xrayed
3. The portion that wasn’t has significant kissing spine with arthritic changes that don’t occur in a matter of 6 months
4. I am not an expert that could possibly know if the entire spine was xrayed or not.

If you can establish each of the items you claim then you have a pretty good story to tell. Is it good enough? It depends on your lawyer, the judge, the jury, the witnesses, etc.

You were wise to consult with an attorney. Now you have to await their case review.

Good luck as you go forward.

G.

[findeight]

Not sure you can prove malpractice here…he didn’t x Ray the part of the spine where it was found 7 months later but you were under the impression he did shoot The Whole back at the time? Is that correct?

Do you have the x rays that were taken in OCT? Were you billed for just the area that was imaged or for the whole spine?

[Elouise]

As someone who has a horse diagnosed with Kissing Spine with only 4 vertebrae involved; if you have 5 vertebrae involved something must of come up on X-ray. My Vet shot 4 films…two of her the wither (nothing showed on those … He was shooting a whole series of neck and back) and two of her back. The KS showed up on both back X-rays. One where is was just beginning and one where it was ending. So if he truly took a back film… there is bound to be some sign of it.

I have a friend where the horse has back arthritis and that is much farther back behind where the saddle sits. My films don’t go that far back.

Cant help you on the malpractice front except talk to a horse attorney and grab your films and get at least two Board certified radiologist’s opinions in writing before you consider anything.

[CHT]

Sounds like the vet did mess up, and I think it wise to consult an attorney. You asked for “x” and did not get “x”.

I do not think YOU have a responsibility to have your own vet look at the x-rays, nor should you have to go over them yourself to make sure all were taken…this is something you should be able to trust the vet to do. This wasn’t a case of misinterpreting the x-ray, but a complete failure to do what you asked, which will cost you $$$. If this was a case of the vet just missing seeing something, vs missing doing something, I would feel differently.

Hopefully you have some back up to prove what you asked for and thought you got, vs what you received.

Good luck in your lawsuit. I hope the horse is able to be made comfortable.

[Venture_Cat]

What immediately comes to mind to me , as a counter to the “well you didn’t question the lack of a full set of xrays even though you asked for a full set”— you are a lay person not a vet. You hired a vet because you are not a vet. You as a lay person can not be expected to understand/ have the experience and training …to read xray films or even know whether a total xray of the spine is represented in the films presented to you. You have contracted the professional services of a licensed vet to do this specifically because it is not within your ability. You have to trust their professionalism/expertise ( and thus they owe you duty of care). You did trust their word that they performed a thorough enough exam to say the horse was OK. ----------how can you as a lay person be expected to question the vet or read xrays yourself (thus we now have a question of negligence/ breached duty of care)?

Now, aside from that, my other immediate thought is to take your xrays that you had done - to a 3rd party for evaluation of whether 1.) they show clear spine or missed lesions 2.) whether they represent normal locations/views spinal xrays for a horse presenting with the location/symptoms of back pain the horse presented at the time of xray 3.) whether the set of xrays/ location of views is considered sufficient/within accepted practices when a owner specifically requests a full set of spinal xrays.

I can not speak to veterinary fear of being sued–but in MD’s being sued, and loads of other things people get lawyered up for…if the evidence is enough, if the cost of fighting will be over enough…many get settled upon out of court…before court.

everyone is afraid of cost of lawyers and litigation…and word of mouth damage. Use that to your advantage.

in synopsis

Step 1) How am I supposed to read my own rads/ know a full set or parts of the spine if I am not a trained vet?

Step 2) What does 3rd party say re: xrays and whether they conform to normal expectations given owner request for full set + horses presenting symptoms/locations of pain

Step 3) How much compensation are you seeking? Is that figure going to be enough to cover you sufficiently/ and are they likely to view it as preferable to paying lawyers and court battle. AKA: make a offer you can live with and they may prefer not to refuse.

[fordtraktor]

I have a hard time imagining that one could get full X rays and not glance through them. Were they digital? I am far from a vet but I can certainly tell if the whole spine was done because, well, you’d have files of the whole spine. I always look at my X-rays just to see if I have questions and got the shots I wanted, and my medical training is Zil. Also if a horse palpates back sore, I would want to look at the spot for sure. Actually? If it palpates back sore just pass! It is never anything good. I will never buy anything back sore again.

That said, consult an attorney if big $$ are involved.

Could you win a negligence case? Who knows and my DH is a respected torts professor. You can definitely spend a lot of $$ trying. Did you submit the request for full spine in writing? That would help. He said/she said is an expensive crapshoot.

[Toblersmom]

I’ve seen errors go in both directions–false negatives and false positives. Using vague terminology like “behind the withers” and “middle back” I’ve got no idea which specific vertebrae were imaged when. I would get an independent review of both sets before I brought lawyers in.

[Guyot]

So something similar happened to me. I PPE a young horse. Took 2 shots of all joints and neck/back. I was super clear that I wanted clean X-rays… no issues what so ever, etc.

There was a little fluid in one hock on physical exam although nothing else showed in flextions etc. I said let’s start there. We shot four views of that joint to be really sure, because of the fluid… was told nothing there. Continued with the rest of the vetting. Everything checks out really good.

I ask again three hours after the start (vet did not skimp on time with us) everything looks good; absolutely nothing in that one hock that we questioned in the beginning.

Vets exact words “really boring X-rays… everything looks great”

I go home with my new horse; asking vet to forward all records to my home vet. My vet two weeks later… didn’t you say you took X-rays? Me yes…?? I didn’t get them. I got right on the phone and they sent them… she takes a look and says thought you said her X-rays were clean? I’m like yes I was told that, etc.

long story short… there is the start of some arthritis in lower hock joint of the one hock we took the extra shots of. I was so pissed! If I had been told I would have stopped the PPE immediately.

Anyway, I could have done many things differently; I could have sued, there were witnesses to this and my many clear “I want nothing in these X-rays, no exceptions” …good friend who is also horse professional and many of his staff present. I could have sent the X-rays to my vet for review, I could have tried to return the horse based on this as the seller was horrified and wants repeat business.

In the end I kept my horse (who is doing great and has so far no issues and I will keep very close eye on. Fluid resolved in one day and knock wood hasn’t been seen since) I didn’t say or so anything… but I will never use or trust this vet and his clinic ever.

I can also say that I don’t think he meant to do this… he just missed it while doing the PPE and when he went back to review it… he tried to downplay and minimize it in the report and left the X-rays out there to “speak” for him.

For me, he should have picked up the phone and called me immediately and told me he missed something but didn’t think it was an issue going forward for what I wanted. Offered me to credit back the extra X-rays or whatever. Instead he dodged my calls and never returned a call to me or my vet. Makes him sketchy in my book. We all make mistakes but he should have owed his… instead I do.

Luckily I think I own a gem of a horse and nothing is perfect… but at the time I really was angry and felt very betrayed.

OP make the best decision for yourself and I wish you and your horse the very best of luck.

[anony2]

@fordtraktor

I have a hard time imagining that one could get full X rays and not glance through them. Were they digital? I am far from a vet but I can certainly tell if the whole spine was done because, well, you’d have files of the whole spine. I always look at my X-rays just to see if I have questions and got the shots I wanted, and my medical training is Zil. Also if a horse palpates back sore, I would want to look at the spot for sure. Actually? If it palpates back sore just pass! It is never anything good. I will never buy anything back sore again.

I have never done back xrays before in a PPE, my previous horse ALSO had kissing spine turn up after PPE (but no back rads going in), which is why I specifically went looking for Kissing spine on this horse. The previous experience spooked me. I have two rads, They show about 10 total vertebrae (ish). I have no idea how many vertebae should be on a back rad, and I have no idea how the vet who palpated the horse sore didn’t shoot the sore area.

As far as why I bought him? He had just come from the breaker where he was started in a giant ill-fitting western saddle. A little back soreness from that experience didn’t surprise me at all. And. I WAS RADIOGRAPHING THE BACK TO MAKE SURE.

[anony2]

@Elouise

As someone who has a horse diagnosed with Kissing Spine with only 4 vertebrae involved; if you have 5 vertebrae involved something must of come up on X-ray. My Vet shot 4 films…two of her the wither (nothing showed on those … He was shooting a whole series of neck and back) and two of her back. The KS showed up on both back X-rays. One where is was just beginning and one where it was ending. So if he truly took a back film… there is bound to be some sign of it.

I have a friend where the horse has back arthritis and that is much farther back behind where the saddle sits. My films don’t go that far back.

Cant help you on the malpractice front except talk to a horse attorney and grab your films and get at least two Board certified radiologist’s opinions in writing before you consider anything.

The rad I got back from the new PPE is so clear even I can see the 5 vertebrae and the changes in them. I looked at my old rads and none of these vertebrae are present in the views I do have.

[OneTwoMany]

Unless you have it in writing that you asked for a full set of spinal radiographs, it sounds like you might be hard pressed to prove your case in court. You accepted and paid for the radiographs, so that works in the vet’s favor. The rest becomes hearsay if you cannot back it up in writing.

You didn’t mention if the horse has been sore or lame while in your ownership. I would guess not if he is being offered up for sale. If his back hasn’t presented any issues during your ownership, perhaps you could explore a lease. There are plenty of horses out there that don’t vet 100% clean but are healthy and sound and perform their jobs. A lease can be a terrific compromise for all involved.

OP I’m sorry you had this experience. But it is a good opportunity to remind buyers to always send the PPE results to a trusted vet if that trusted vet is not performing the exam themselves.

We purchase horses on a fairly regular basis. I never rely on the vet performing the PPE if he is not my regular vet. My vet knows me and understands my standards. He has vetoed many PPE’s that the attending vet said looked just fine.