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How do you deal with an unexpected equine death?

At BEVA Congress 2019, Tim Brazil discussed actions to take if a patient dies suddenly

23 October 2019, at 9:00am

Dig a big hole, call the knackerman or make a cup of tea – those were the three suggestions that Tim Brazil’s colleagues offered for his BEVA presentation on dealing with an unexpected equine death.

On balance, he would probably support the last option. In this situation, there is nothing that a practitioner can do for the patient; it isn’t necessary to immediately dispose of its carcass and the clinician’s first thoughts must be for their client, he explained. The horse owner is likely to be distressed by the sudden loss of a much-loved animal and it is the vet’s responsibility to take charge of the situation, including offering reassurance and sympathy.

But as a Veterinary Defence Society claims consultant, Tim also noted the need for the vet to choose their words carefully and to do a thoroughly professional job. This was particularly so in those cases where the horse has died while under veterinary care or – even worse – actually during a medical or surgical procedure.

After talking to the owner, the vet can get on with dealing with their professional duties in examining the animal and investigating the likely cause of death. But the first task is to confirm that the animal is actually dead – both Tim and a couple of audience members recalled occasions when the person reporting the death had been mistaken.

The next step will be to positively identify the animal by scanning its microchip and examining its passport. In situations where the owner isn’t present or on a large commercial premises, it may also be necessary to find the agent responsible for the animal to make some decisions and to provide a full clinical history, he said.

For animals found dead at pasture, there may be an environmental cause that could affect other animals on the premises. In cases that have showed potential signs of atypical myopathy, for example, Tim advised checking the area for sycamore seeds and seedlings – the practice should be warned to prepare for a situation in which it will need to provide intensive treatment to any other horses that have been exposed to the toxin, he said.

In the worrying situation of a horse expiring during treatment, Tim said “the important thing is not to jump to conclusions; the horse may well have died for reasons totally unconnected with that treatment. If it looks as though the death may be an unexpected reaction to a drug treatment, don’t try anything heroic, take your time, close the door and wait for the dust to settle.”

Tim reminded colleagues of the need for honesty in answering the client’s questions. It was appropriate to offer sympathy for the loss “but don’t admit liability as that will likely negate your professional indemnity insurance and then you could be in big trouble,” he said.

Whatever the cause of death, the veterinarian should not be in a hurry to organise disposal of the animal’s remains. There is a need to question the owner about their plans and it is important to find out whether the insurance company would want a post-mortem examination, even when the animal was old or of low value. “If you haven’t much experience of this task then it may be necessary to involve a colleague from the practice or to refer the case to another centre with a specialist pathologist,” he noted.

Tim reminded his audience that they should not feel totally alone when dealing with the death of a patient that could have considerable financial and reputational implications for the clinician involved. They should be ready to call others for advice, particularly senior colleagues at the practice or a representative of their indemnity insurance provider, he said.

It is also important to write down full details of the case management for inclusion in the clinical records. Any relevant photographic images or other documents should be saved and colleagues present during treatment should be asked to record their recollections of what happened. “Remember that it may be a year after the incident that you first find out that a complaint has been received,” he warned.

Tim urged colleagues to consider the circumstances leading up to medical near-misses just as carefully as those incidents in which an animal has died. He recalled an occasion during his own career when he was presented with two bay thoroughbreds, one requiring euthanasia and one sent to be castrated. It was only when preparing to deal with the first of these horses that a stable lad ran across to warn him that the second horse had already received surgical attention. “The lesson here is to scan the chip when the horse is brought in – and again before you put the bullet in the breech.”

He recommended that all colleagues should make use of the VDS VetSafe website to record any incident of either clinical errors or close shaves. “We can use this to build up a database of incidents that will form part of our drive for better clinical governance and allow the profession to develop processes to minimise the risk of harm to our patients.”