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It’s your duty to KNOW what something like that means!!!
You noted that you have some experience in doing this. You do it regularly. That makes you a “professional” in at least the practical meaning of that term. If you are going to be something you have to behave like that something.
The vet. had a duty to perform a PPE IAW the standards of the the vet. profession in that area and to communicate the 5Ws of the exam to the client. If you wanted a full set of spinal radiographs you needed to tell the vet. you want a full set of spinal radiographs. Speaking in plain English will generally do the job. You are the client. You pay the bill. You call the tune. If you don’t know what tune to call then you ask the vet. for their opinion. Or you research in other sources. Or you ask a different vet. for advice. But the burden is on YOU to communicate to the vet. precisely what you want. And what you’re willing to pay for. And then follow up and ensure that it was done. The vet. has a duty to listen to your direction and then comment as appropriate. They have a duty to carry out your direction. But if there is a difference of opinion in what ought to be done then your opinion wins. If the vet. does not want to do that then they terminate the relationship. And you find a new vet. to do the job.
I get that this is disappointing to you and might have lost some Real Money. Professionals (DMVs, MDs, JDs, horse traders, etc.) are often very good but I’ve never met one that was omniscient. (Although I’ve met a few who thought they were.) That’s why the dialog between professional and client is important. You have, sadly, learned a hard lesson. I doubt that there is any viable legal recourse for you. But I’m not omniscient, either. So maybe you do and that’s why I said talk to a lawyer (which you have done).
As the old song goes, “Life’s a dance, you learn as you go.” Learn from this.
G.
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Kissing spine and arthritic changes are tow different things. Kissing spine involves the spinous processes. Arthritis involves the facet joints. Imaging facet joints in the spine is a very different technique as compared to looking for KS.
Did the 2 other vets take their own sets of x-rays?
I agree with others, you are too focused on radiology versus the complete exam. I am a research scientist in orthopedic spine so I understand how hard it is to get the images and how your statements are indicative of your lack of understanding in the field.
To the others who are saying the first vet did not use their full ability, how is this determined? There is no standard of practice for a PPE. I can get 10 or 20 other vets who would back up the first vet. We see this all the time in the human medical field in product liability cases. MDs argue against MDs. Scientists argue against scientists. I read the medical records and then use my expertise in a field to form a legal opinion. The opposition does the same.
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OP, I’m just here to commiserate. I’m an educated lay person, and I’ve taken three different horses to a VBN vet practice for back and/or neck x-rays. I recently watched the VBN vet flip back and forth through the images a few times before he was 100% on which vertebra were on which image. (The machine had them out of order.) I can tell the withers from the sacrum and C1 from C7, and I can spot an obvious abnormality, but beyond that I’m trusting that the professional I hired is providing the services we agreed on. I can see how this could happen to a non-vet, even an educated/experienced one. At the end of the day, you are not trained in radiology. Hence paying someone who is.
Whether you have a case for malpractice, I have no idea. I’ll leave that to the lawyers. Just, I’m sorry you’re dealing with this. And kudos to you for doing the right thing by the horse.
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Kissing spine is not arthritis. This is correct. It is also difficult to image the thoracic and lumbar facets well on a field machine. The views you want to look for KS may not be the same type of view you would take for arthritis of the articulate facets. So, you may be looking at needing a few images versus a lot of images.
I am not sure from the story if the horse has KS or arthritis or both. I’ve also seen one vet call something KS that another vet will just see as bone oedema / sclerosis without actual impingement. Yet another vet may call the second scenario “pre” kissing spines, although if there is no impingement, who knows the reason for the bony changes or whether it will become impingement in the future.
What you have is back pain that was not properly diagnosed. On the one hand, looking for KS on a PPE is not common / ordinary. On the other hand, you asked the vet to further investigate an area that appeared to have clinical significance. Whether what was done next was reasonable given limitations of field imaging would be up to weighing expert opinions. However, I think just applying the usual PPE standard would not apply because an area for further investigation was identified and more studies requested. Although there also really is no “standard” PPE—some people want a pretty basic exam and some want the entire horse imaged, and everything in between. It would be analogous to say clinical exam identifies something abnormal in a soft tissue area. Perhaps previous injury, perhaps current problem. If you then request an ultrasound to be sure the tissue looks good, that’s not standard in a PPE, but one would hope that the vet would not miss an active lesion. Depending on the particular skill of the PPE vet, though, you may want to send images off for secondary review.
OP, I am fully in the camp of this totally sucks and that you didn’t do anything wrong and there is nothing you or any reasonable person should have done differently.
The vet is in a large practice, so it and its malpractice insurance carrier is probably used to this. Be clear about what you want: the cost of the horse + expenses to date? Future expenses until when? Lost opportunity damages is probably not in the cards.
Good luck
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I strongly disagree.
OP, you are not a vet. Hence why you hired the services of one. You asked for a full back series. You did not get one. You asked for a full back series, to rule out a condition that, if present, would be a deal breaker for you. Whether or not the horse can or will be able to perform to the hoped for level, and any other details, are really beside the point. If you had received the services as requested, you would not have purchased this animal. There really isn’t much else that needs to be considered.
Consider me also fully in the camp of this totally sucks and that you didn’t do anything wrong and there is nothing you or any reasonable person should have done differently.
I really hope you receive some compensation. As Punchy mentioned above the practice probably has malpractice insurance.
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Thank you for the clarification. You can’t see the articular facets in that image, so arthritis cannot be seen from that xray. What you can see is impingement (KS) and associated sclerosis (the white spots) of the dorsal spinous processes. This is a type of bone remodeling, but it =/= osteoarthritis. Arthritis affects cartilage and subchondral bone, bone or cartilage at the joint margins, and it can include bone sclerosis, spurs, osteophytes, chondral lesions, cysts, etc. Simply, arthritis requires a joint to be involved. Bony changes that are not associated with joints are not “arthritis”.
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Digging up this thread from 3 years ago. FWIW, though it took a (very) long time, and COVID didn’t help. But we recently settled this case, and I am happy with the outcome.
Not that anyone has thought about this except me, but I thought worthwhile for those to know.
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I appreciate people who come back and update on situations like this. I’m glad you got a satisfactory outcome OP
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Oh wow! Good for you!
Thank you for the update @anony2!
So glad this was resolved in a way that left you happy with the outcome.
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Can I ask a question related to this thread? This was super educational and also made me nervous about the back x rays I got that came with my horse before the PPE was done - I had the PPE vet examine them, they passed as all clear, but now I’m just nervous. Is there an article or anything out there that tells me how to read back x rays or even just how many shots there should be? I have five total and it seems to be a complete picture of her back but I truly have no way of knowing for sure LOL.
Reading radiographs is an art and takes a fair amount of practice. I suppose, at the very least, you might be able to contact a veterinary radiologist or teaching hospital and ask them what their standard protocol is for number and type of views for a spine series.
You could have a set of radiographs sent to a radiologist for interpretation and comment, and they would quite likely point mention that additional views were warranted for a complete exam.
This paper from an AAEP meeting might be helpful to you.
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I’ve had multiple horses’ back x-rayed on multiple occasions by different vets. 4-5 is typical. I’m also in a kissing spine (KS) FB group, so I’ve seen a lot of x-rays and would say I am reasonably comfortable determining if the whole back has been imaged and if there are basic signs of KS (they are usually fairly easy to see).
