Hotstuff and I had done this before - waited in the car until it was his turn for surgery. He'd had two successful cancer surgeries (lung cancer on 6/10/14 and mast cell tumor on 11/5/14) earlier this year at UF, and we were delighted that he was in remission from both kinds of cancer. I adopted Hotstuff on Mother's Day 2009. He was a jolly 106 pound hunk of love back then, but now he was a healthier 85 pounder. One of the first things I learned about him was that he would experience a lot of anxiety when in a cage, but other than that, he was a very good natured, laid back, uber friendly Weimaraner. Because of his cage stress, any time he had a procedure done, fortunately any medical facility I took him to would allow him to stay with me until they were ready for him, hence less stress.
Hotstuff had been diagnosed a couple of years ago with endothelial decompensation in his right eye. He had surgery for this but it was still progressing. That's why his right eye looked opaque. The reason for this current eye surgery, however, was due to a large corneal ulcer that was on the same eye. This ulcer was 70-80% through the thickness of the right cornea.
When they took him back for his surgery, I waited in my car, and a little later, Dr. Espinheira called me and asked if I'd meet him in the lobby. I went in immediately and he took me into a room. Then he said something I will never forget. He said something terrible had happened. I asked if Hotstuff was alive. He said yes, but they'd removed the wrong eye by mistake. He then told me that the OR tech prepped the wrong eye. I then asked to speak to that OR tech, but was not able to speak with her for at least an hour. I kept asking.
Finally, I got to see her. The OR tech told me that she prepped the correct eye. Pics confirm this as well. After she told me that, I told her we had nothing further to discuss and she left the room. As soon as she left the room, Dr. Espinheira told me that she had changed her story from before.
I could not understand what he was saying, because when I looked at Hotstuff, I could see a large shaved area around only one eye. I asked him about this. How could he not tell which eye was shaved. Dr. Espinheira told me that it was hard to see which eye was shaved because it was wet and because Hotstuff's fur was so short anyway. I asked Dr. Espinheira who draped Hotstuff for his surgery and he told me that he draped Hotstuff himself.
You can easily see that there was only one eye prepped - the bad eye. However, the good "unshaved" eye was removed first by mistake. My nearly deaf 13 year old baby was left instantly blind. We still had to have the bad eye removed as well. As you can see in the pic before surgery, the bad eye is actually opaque, while the good eye looks like a regular eye.
I've since been told some other details about what happened in the operating room that day... Hotstuff's surgery took place in the smallest operating room at LSU's Vet Teaching Hospital. First, his correct (right) eye was shaved by a tech. Then a different tech did a sterile scrub, so what that means is Hotstuff was "prepped" correctly twice. Dr. Espinheira draped Hotstuff himself, which means you can only see the eye getting the surgery. The resident, Dr. Courtenay Brines, was not yet in the room when Hotstuff was draped. She came in after that. Once the drape was on, only Dr. Espinheira and the resident were closest to Hotstuff. There were also two students and two people from anesthesia in the room.
Hotstuff after wrong side surgery
As you can see in the photo below, there is only one eye shaved - the bad eye. However, the unshaved eye - the good eye - was removed. Then we still had to have his bad eye removed.
Why did Hotstuff go to LSU rather than his regular Ophthalmologist?
Hotstuff had previously had eye surgery for endothelial decompensation at Southern Veterinary Eye Care in Mandeville, LA. I had discussed with Hotstuff's regular board certified Ophthalmologist, Dr. Gabe Van Brunt, that if we ever encountered a surgery because of his eye that I would want the surgery done at a Vet Teaching Hospital because that way there would be anesthesia people in the room with him. All "anesthesia" people do is anesthesia. The reason for my wanting this is because just months earlier when Hotstuff was to have an MRI at UF, he experienced respiratory arrest. He subsequently had two separate cancer surgeries (lung & mast cell tumor) and both surgeries were performed at UF Vet Teaching Hospital where there was a board certified anesthesiologist in the room. He had his surgeries at UF - and he was getting his chemo treatments at LSU which was much closer to home (only 2 hours away versus UF which is 6.5 hours away. Hotstuff was in remission from both kinds of cancer.
Hotstuff 2 weeks after surgery. You can still tell which eye was shaved.
What is malpractice? Malpractice is an error that a professional, who is expected to have a certain level of competence because of special training and experience, should not make.
I hired an attorney to send Dr. Espinheira a letter of demand for the veterinary malpractice that Hotstuff suffered.. I was told this was the thing to do before filing a lawsuit. Dr. Espinheira immediately turned the matter over to LSU since they covered his insurance. Months later, I went to a mediation that was suggested by the the State of Louisiana, which is who I would be suing if no settlement was reached.
I was finally offered $17,500 as a settlement for this malpractice, but it also included a non-disparagement agreement, which meant that I could not share or talk about Hotstuff's story, so I turned it down. It was explained to me that a non-disparagement agreement meant that I could not say anything negative regarding the parties involved. I specifically asked if I would be able to share Hotstuff's factual story under this agreement - just the facts - and I was told no. That's why I turned it down. Prior to mediation, and on the first day of mediation I made it clear that I would not agree to a non-disparagement agreement, not even for a million dollars. It as also relayed to me that the reason for the non-disparagement agreement was so I would not bother/harass/stalk Dr. Filipe Espinheira.
Some people want me to shut up about what happened, but Hotstuff was my dog and this is his story. I will share it. That is the truth, my first amendment right and my responsibility to Hotstuff. I was told during mediation that Dr. Espinheira was very upset about all of this. I asked exactly what he was upset about, and I was told he was upset that I had contacted his superiors, that the news media was calling him for interviews, and that I had filed complaints against him.
Note: since the vet's insurance was carried by the LSU Vet Teaching Hospital, the sum of money was being offered by the State of Louisiana (i.e. taxpayer $), not by the vet. He was insulated from any accountability.
My AVMA complaint
I filed a complaint regarding Dr. Filipe Espinheira with the AVMA (American Veterinary Medical Association). They initially told me I should contact the Louisiana Board of Veterinary Medicine or the Louisiana Veterinary Medical Association. I called the LVMA and they told me they were created for the veterinarians and that I should contact the LBVM, which is for the public. When I contacted LBVM, they said they have no authority over a vet who is not licensed in the state of Louisiana. They also told me Dr. Espinheira was not legally required to be licensed by LBVM for his practice at LSU SVM (School of Veterinary Medicine) since a law was enacted by the State Legislature providing an exemption to licensure for faculty veterinarians at LSU SVM. So after all of that, I was then told by AVMA that my complaint would be submitted to the Chair of the AVMA Judicial Council for consideration. The AVMA Judicial Council has no legal authority; it's action is limited to suspending or revoking a veterinarian's membership in the Association. See below AVMA's reply. The case is closed. I have been repeatedly trying to get someone there to give me a better explanation but now it appears I am being ignored. I do not think an explanation of their decision is too much to ask for considering what happened to Hotstuff.
My email to AVMA as I try to see my complaint through to completion
AVMA Complaint = Closed
What I hope pet owners understand from my endeavors:
1. If Dr. Filipe Espinheira had been required to be licensed in order to handle pets at LSU, I would be able to file a complaint against his license, but he did not have a license.
2. If LSU Vet Teaching Hospital's standard operating procedures included requiring surgical teams to use a surgery checklist for patient safety, the chances are great that Hotstuff's wrong side surgery would have been prevented.
3. Why should Hotstuff's story be important to you? To raise everyone's awareness about the things I didn't know that were critical to Hotstuff's well being - the most important being the SURGERY CHECKLIST.
Life after surgery - getting help
I took Hotstuff home the same day he had his wrong side surgery. My mind was completely in solution mode - what was I going to do to make this transition as easy as possible for him? My mind was racing. I needed answers, and I needed them now. I contacted our regular vet, Hotstuff's regular ophthalmologist, along with numerous other specialists who had either seen Hotstuff before or were still seeing him. I knew that if they didn't know or have resources to help Hotstuff and me, then they would know of some good contacts who would. I was pinning all my hopes on that.
Hotstuff had just gone through a major surgery, so he needed time to recuperate. He slept a lot and seemed to rest as comfortably as he could in an e-collar. I began preparing the house for him using the advice that several of his medical caregivers suggested: Wherever he would lie down, I'd make sure I put one of my t-shirts or sweatshirts under or next to him hoping that my scent would comfort him. I massaged his head and body to help relax him. I ordered a couple of supplements and essential oils that are known to relax/reduce nervousness in case we needed them later. I ordered books about how to care for blind dogs. One book was for blind/deaf dogs, so I looked forward to getting it. I ordered several types of harnesses to see which one worked best for leading him. I ordered a lot of Tracerz, which are small scented adhesive things that can be placed in doorways and other helpful places. I used a lot of these on doorways and walls, even the edges of all furniture to help him know something was there. I also got fluffy bath rugs to place in every doorway, and runners to go on the tile floor and leading to his water bowl.
I also emailed Dr. Espinheira asking him for resources on how to help Hotstuff in his new life. He emailed me back, and told me he was really sorry and he wished he could go back in time and fix his terrible mistake. Then he said he was not familiar with any good resources to train blind and deaf dogs, however the rule of thumb should be using the senses that will work well (scent and touch). He included one link about training a deaf/blind dog. I received this email on Dec. 25. I was disappointed that he did not have more to offer us.
The next day, I talked with someone familiar with this situation and they told me that Dr. Espinheira had been instructed by his superiors to gather resources to give to me and that he was given a deadline in which to do it. Sure enough, on Dec. 28 I received another email from Dr. Espinheira containing more links/ideas. It is posted below. As you can see in this email, he apologized for his terrible mistake. I really hope that he is following through with the things he detailed in this email on what he plans on doing to prevent this from ever happening again. This would definitely help future veterinary ophthalmologists who will share the classroom and operating room with him.
My ACVO complaint = Closed
Pets are considered property
In the eyes of the law, pets are viewed as property, so recovery in pet malpractice cases - barring legislative reclassification - may often be limited to loss of value, not loss of relationship. In some cases, courts have awarded money to pet owners for mental anguish. State laws vary on this issue. It will take legislation to change these "pets are property" laws and we have a long way to go. Here are some interesting articles about the legal classification of companion animals:
What we can do: Find out how companion animals are viewed by the courts in the stat in which we live, and contact our legislators about our concerns on this issue.
Please share Hotstuff's story
Please help share Hotstuff's story to help other pet owners become more informed about the questions they may choose to ask and to be aware of the choices they have. I researched, I googled, I made lists of questions prior to every procedure Hotstuff went through. But there were questions that I just didn't know to ask. I now know. Keep reading and those questions will be discussed. We all have a choice of where to take our pets for their veterinary care. Always ask questions. The more questions, the better off our pets will be. If we don't like the answers, we are free to search for another animal health care provider.
Did you take Hotstuff to a Teaching Hospital because it was cheaper than taking him to a real doctor?
I've taken Hotstuff and my other dogs to numerous specialists over the years, this has included private specialty clinics/hospitals as well as three different Teaching Hospitals. Rest assured, there is absolutely nothing cheap about going to a Teaching Hospital. You will find cutting edge technology and multi million dollar equipment there. Yes, students are involved, but there is at least one board certified specialist in every department and they are the ones who perform the actual surgeries, usually having a resident in the room as well.
Depending on what service your pet needs, you may find that a Teaching Hospital is the only place in your immediate area that could provide such a service. We are lucky that more and more private specialty clinics are providing more and more services these days. I've found that going to a Teaching Hospital is usually an all day affair and takes longer than a specialty clinic. First you see the student and go over the case, then they do exam on the pet and then you sometimes talk to either the resident, who is already a DVM but not yet board certified, or the board certified specialist, or both.
Depending on what service my pet needed, I would then decide who could provide us with that service and try to choose the most qualified or most experienced specialist, and then go to wherever they were, whether it be a private hospital or a teaching hospital. Since Hotstuff was already an oncology patient at LSU, that's how we ended up there with his eye ulcer problem that led to his wrong side surgery.
At teaching hospitals, you never know who is licensed and who isn't, since many of them offer exemptions to non licensed vets as long as they work/teach only at the teaching hospital. This was news to me. Another thing to consider is if one specialist in a department is not licensed, another specialist in that same department probably is. Ask questions. The only way you can you can hold a vet accountable for a mistake is if you file a complaint against his/her license. That cannot be done if they don't have one!
"Gaming" the internet
The screen shots below were taken from Reputation.com's site. They advertise that they "fix negative search results". What that means is they try to bury what the client may not want people to see. Filipe Espinheira appears to be a client. You only have to do a search of his name to see this. Lots of new sites involving his name have been showing up since after Hotstuff's wrong side surgery. The goal would be to push down those search results that are about what happened to Hotstuff, since that was obviously connected to him. Click here for an article I read that explains a little more about how people do this.
Why you should care about search results: If you are searching for a vet specialist or doing research on a vet specialist you have found, you may want to notice if they have a lot of mirror/duplicate websites listed. If they do, you should keep researching, because there is a possibility they are trying to bury something negative about themselves. Sure, they have the right to do this. And we as diligent pet owners have a right to keep digging for as much information as possible before entrusting our pets to anyone.
No surgical checklist was used
I've also been told that at the time of Hotstuff's surgery, the LSU Vet Teaching Hospital did not use a surgical checklist, but after Hotstuff's incident, they "kind of" started implementing a checklist. I'm told they use a camera for some surgeries (lengthy) but one was not used for Hotstuff's surgery. After Hotstuff's surgery, when the drape was removed, I'm told Dr. Espinheira put his hands on his head and said "oh my God" and then left the room immediately. Apparently that's when he came to give me the horrible news that he had removed Hotstuff's only good eye. I hope Hotstuff's story can help to explain why a SURGERY CHECKLIST is a very powerful tool in improving patient safety in surgery.
Hotstuff's good eye
When I was visiting with Hotstuff later that afternoon, Dr. Espinheira also made the comment to me that we really don't know how good the "good" eye was. I told him I did indeed know how good it was, that I had pics as recent as day before surgery, and that Hotstuff had a regular board certified Ophthalmologist (in Mandeville, LA) who had seen him numerous times over the past two years. I have records on how good that good eye was. The only reason we ended up in Ophthalmology at LSU was because I only knew Hotstuff was not well, not himself, but he wasn't squinting so I thought his problem may have been with his chemo, so we visited LSU oncology. Even the oncology folks did not spot the deep ulcer on his eye, but they got an opinion from Ophthalmology dept. just in case, because his third eyelid was up. Ophtho confirmed it was an eye problem - they described it as a deep infected corneal ulcer.
Hotstuff's left eye - the one I refer to as "good" because he could see very well with it, was described by his regular Ophthalmologist as follows: The left eye had an incipient cataract (<10% of lens volume) and nuclear sclerosis as well as a small calcium deposit on the cornea. On his most recent exam with Dr. Van Brunt, Hotstuff could see just fine with this eye. As you can see by pics, this was definitely his good eye. He got around the house just as well as my other dogs and he never bumped into anything.
Hotstuff's bad eye
This is the eye that was diagnosed with endothelial decompensation. He had surgery for this previously (gundersen flap) but it was still becoming more opaque looking because of this disease. He still had vision in this eye, but I worried that at some point he wouldn't. We were managing it with rechecks and eye drops.
When we realized we had another issue to deal with in this eye, it was upsetting. I wanted to do what was best for Hotstuff overall, and I always worried when he had to undergo anesthesia because of his age and because of his incident of respiratory arrest in the recent past. I decided to have Hotstuff's bad eye enucleated for several reasons:
1. To minimize his pain, because it was definitely bothering him to the point that I knew he was ill but I didn't even know it was because of the eye.
2. There was a possibility of future surgical interventions if we tried to manage this any other way, and with Hotstuff already being 13 years old, my thought was if he has to have surgery on this eye, better to do it now than later.
3. Healing time was also a concern. Hotstuff had only taken 2 doses of his chemo. We had to stop chemo for the surgery since it would affect healing and then restart after he was healed. I thought it would be better to do the surgery now rather than wait until after he had even more chemo in his system.
I also specified that I did not want them to place a prosthesis after removing his eye. A prosthetic globe would have made the area where his eye used to be look less "sunk in" after surgery. The reason I did not want this is because there was that possibility that it could cause problems i.e. rejection of prosthesis, and I did not want Hotstuff to go through an unnecessary surgery.
Judging by the pathology report after the fact, my vet told me that trying to save the remaining bad eye would have been difficult at best and in the condition it was in, even if they could have saved it, there was almost no chance it would have had vision. Once the good eye was mistakenly removed all options for a vision outcome were gone. The reason for this eye surgery on 12/19/15 was due to a large corneal ulcer that was on the same eye. This ulcer was 70-80% through the thickness of the right cornea. The cause of the ulcer was unclear.
Why Hotstuff was euthanized
After surgery, Hotstuff was lost, but showed tiny improvements, and was monitored 24/7 at home. He was quiet and rested. I was reminded by his regular Ophthalmologist that he'd had a major surgery and a couple of weeks of rest would be good before getting into much training. We kept things small at first, leading him to the three main areas: his food and water bowls, his bed and the back door. The first two weeks following surgery while he recuperated, he was quiet and slept a lot. He would sleep through the night as well. Then after those first couple of weeks, he started whining quite a bit. We would fulfill all needs (water/food/going out) but he would still whine and bark. I was trying everything I could think of, took all advice that came, got books on blindness, scent markers for the house, ordered every accessory that could possibly help, got throw rugs to help remind him of where he was in the house, used a harness to help lead him - all of which LSU reimbursed me for. Luckily all of these things arrived during his recuperation.
The whining persisted, he would also bark quite a bit. Usually he would only bark if something wasn't right, or if he wasn't satisfied, and I'm sure he wasn't satisfied with being in the dark all the time. It's almost as if his patience had run out.
We put him on anti anxiety meds and supplements for his severe stress but I saw no improvement. He would pace, lie down, get right back up acting as if he were not satisfied, barking and whining all the while. As I worked with him to help him learn the house, he seemed to be ok being led into the back yard. He would sniff around and do his business and then stand still and begin barking. I'd have to lead him back inside with treats in order to get him to move. He would not agree to move unless I offered him treats. I tried to break the barking cycle with a variety of things but the only think that worked was food. He also experienced what I describe as mini meltdowns at certain points inside the house, on the driveway and even in the kitchen. For some reason over his last few days, Hotstuff worsened. The only way I can describe this is to say that the regression was as if he had fallen off a cliff. I didn't know what had changed. We believe Hotstuff was suffering from canine cognitive dysfunction which was brought on by his traumatic experience of becoming instantly blind. He would crouch, tremble, did not want to move around at times, he would whine, bark and moan and I could not even console him. I'd try to reassure him and he would pull away or get up and stand across the room. He acted like he didn't know what was going on, as if he was afraid. Before this, I had never experienced not being able to console one of my dogs. I would use treats to lead him to his most comfortable, favorite places in the house, like his bed or the couch, but he would not settle down to relax. I'd take him to bed but he would only get back up and stand somewhere and begin whining/barking/moaning. I monitored his temperature and it kept spiking because of his stress, then after the dose of anti anxiety meds it would come back down but he would remain upset. His poop got really loose as well. I consulted our vet a lot throughout this whole time and would keep him posted on Hotstuff's status, especially before/after meds. I racked my brain to try to think of anything that could make him happy again.
As his mom, I thought I'd always be able to console my baby, but he just didn't know what to do with himself. The noises that came out of him cut me to the bone, and I knew it was time. I had promised him that he and I would fight through this together and hopefully get through it. I also promised him I'd never allow him to suffer. I spent time with my arms around him just holding him, hoping that I would receive some magical sign telling me what to do. He slept very little, even while on some serious anti anxiety meds. I kept wondering why he couldn't relax with me, just knowing that he was safe with me and his pack. I felt like the Hotstuff I knew was no longer here.
We were scheduled to have a phone consultation with an animal behaviorist the next day. I'd sent him videos and told him about Hotstuff's situation. My vet felt like the behaviorist would probably refer us to a neurologist (because of canine cognitive disorder symptoms). However, I believed that Hotstuff had been through more than enough already. I made the decision that Hotstuff had fought a good fight but that he had suffered enough. I had to stop what I strongly believed was his suffering.
Unfortunately, I had to have Hotstuff euthanized on Jan. 14, 2015, 26 days after his wrong side eye surgery. This was the worst day of Hotstuff's life and mine. The sunset years that he was enjoying to the fullest were over, cut way too short because of a wrong side surgery performed by Dr. Filipe Espinheira at LSU, who is now employed by Cornell University.
Hotstuff had beaten two kinds of cancer and his arthritis was being managed successfully. Ever since I adopted him on Mother's Day 2009, I had taken him to a total of seven different animal medical facilities not because he was sickly, but in order to do all I could to make him his best self and to give him the best chance of living a long, prosperous, comfortable life. Before this mistake surgery, he was enjoying daily walks and anything a regular dog would. He smiled a lot with his eyes. I missed that after the surgery. After this surgery, he was even too afraid to walk down the driveway. Another thing I learned after this surgery was just how hard of hearing he was. I used signs and body language to communicate with him before he was blind. We lost all of that when he lost his sight. I instead used scents and lots of touching so he would know where I was - and where he was.
Any vet treating our pets should be required to be licensed, but surprisingly all are not.
This is absolutely shocking to me. What I've learned is the surgeon, Dr. Filipe Espinheira, was not required to be licensed for his practice at LSU's Veterinary Teaching Hospital. This is a problem not only at LSU but at some other Veterinary Teaching Hospitals as well. My opinion is every vet who treats client pets should be licensed. What we can do: Ask our local Veterinary Teaching Hospitals what their policy on this licensure is. Also ask if the specific vet specialist treating our pet is licensed in that state. I've found while some are licensed, others are not. Dr. Espinheira had previously worked in several other Veterinary Teaching Hospitals in the U.S. and was not licensed in any of those states either, in fact he wasn't licensed in any U.S. state. He received his veterinary license from another country and these vet schools accepted that. If something goes wrong under this scenario, as it did for Hotstuff, you cannot file against their license if they don't have one. Just another way of not being able to hold these vet specialists accountable. This is what I mean when I say they are insulated. We spend significantly more money to take our pets to facilities that have cutting edge equipment and specialists who have spent more time getting more educated and more qualified to do what they do. We don't expect gross negligence from vet specialists of this calibur but that's exactly what happened. Note to self: always ask questions.
Why surgical safety checklists are very important
I've also learned that the LSU Veterinary Teaching Hospital did not require that a surgical safety checklist be used for surgeries performed at the hospital. This is HUGE. If a surgical checklist had been used, this could have prevented Hotstuff's wrong side surgery that left him blind. What we can do: Ask our regular vet and any veterinary surgeon if they use a surgical checklist. You can refer to the checklist recommended by the World Health Organization. UF Veterinary Teaching Hospital uses a checklist for every surgery. My hope is that soon it will be used by all vets, vet specialists and veterinary teaching hospitals. I hope Hotstuff's story can help to explain why a SURGERY CHECKLIST is a very powerful tool in improving patient safety in surgery.
More on the World Health Organization's Surgical Safety Checklist
The World Health Organization Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. The 19-item checklist has gone on to show signiﬁcant reduction in both morbidity and mortality and is now used by a majority of (human) surgical providers around the world. This could have prevented Hotstuff's wrong side eye surgery. There's a specific line item that asks if the site is marked. You can view the checklist here or see it at the bottom of this page.
Examiner.com article about Hotstuff
Here's a link to an article that was written about Hotstuff's wrong side surgery. Thanks to Lisa Blanck for writing this. Wrong eye removed by vet, now deaf senior dog is also blind for life.
WDSU New Orleans interview
Here's the response WDSU received from LSU
LSU Veterinary School and Teaching Hospital issued a statement saying, “We reviewed and strengthened our operating room procedures based on this case. We continue to strive to make sure that all policies and procedures are followed to ensure that the best health care is provided to our patients. We review cases in each service to make sure we uphold the pet owners' expectations, as well as our own."
WBRZ Baton Rouge interview
WXXV Gulfport interview
Hotstuff before eye disease
Hotstuff's last night
This video is so hard to watch. It shows what Hotstuff was experiencing. He was euthanized the following day. From the day I met him, he was always loved. After his wrong side surgery, he was never alone for a moment. We are his pack. He is with us in spirit every day. He will forever be in our hearts and our home. I miss everything about him. He was one big hunk of hot stuff, hence the name.
RIP Mr. Hotstuff
Here we are spending time in the car together waiting for an appointment. No matter where we were or what we were doing, our time together was awesome.
Thanks To #TeamHotstuff
I want to thank all of the animal health care individuals who made a positive difference in Hotstuff's life...
Animal Hospital of Orange Grove
Gulf Coast Veterinary Emergency Hospital
South Paws Veterinary Specialists
Southern Veterinary Eye Care
Oncology & Integrative Medicine @ University of Florida Small Animal Hospital
MedVet Rehab & Surgery
Cancer Treatment Unit @ LSU Veterinary Teaching Hospital*
Integrative Medicine @ LSU Veterinary Teaching Hospital*
*Although I won't be returning to LSU Animal Hospital because of the policies there that I feel were detrimental to Hotstuff, I can't say enough about the fine people in the other two services that we visited there.
The Checklist Manifesto
A board certified veterinary surgeon recommended this book to me. It's called The Checklist Manifesto. The author, Atul Gawande is a surgeon. He makes a compelling argument that we can do better using the simplest of methods - the checklist. A simple surgical checklist from the World Health Organization designed by following the ideas described in this book has been adopted in more than twenty countries as a standard for care and has been heralded as the biggest clinical invention in thirty years. I wanted to share some excerpts that stuck with me from this book. I kept thinking about Hotstuff the entire time. I kept asking myself why in the world was a surgery checklist not used for Hotstuff's surgery. This should be used for every animal surgery. What we can do: Prior to our pet's surgery, always ask if a surgical checklist will be used. If not, why not use such a simple tool to ensure our pet's safety?
"Operating on the wrong patient or the wrong side of the body is exceedingly rare too. But the checks to prevent such errors are relatively quick and already accepted in several countries, including the United States. Such mistakes also get a lot of attention, so those checks stayed in."
"If you were having an operation, would you want the checklist to be used?"
"The final WHO safe surgery checklist spelled out nineteen checks in all...they make sure that the surgical site is marked..."
"When we look closely, we recognize the same balls being dropped over and over, even by those of great ability and determination. We know the patterns. We see the costs. It's time to try something else. Try a checklist."
"I have yet to get through a week in surgery without the checklist's leading us to catch something we would have missed."
"...they improve their outcomes with no increase in skill. That's what we are doing when we use the checklist."
"It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us - those we aspire to be - handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating."
"Failures of ignorance we can forgive. If the knowledge of the best thing to do in a given situation does not exist, we are happy to have people simply make their best effort. But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated...It is not for nothing that the philosophers gave these failures so unmerciful a name - ineptitude."
"...you have to get the knowledge right and then you have to make sure that the many daily tasks that follow are done correctly."
"It seemed silly to make a checklist for something so obvious."
"We need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies. And there is such a strategy --- though it will seem almost ridiculous in it's simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies. It is the checklist."
"'This has never been a problem before,' people say. Until one day it is. Checklists seem to provide protection against such failures. They remind us of the minimum necessary steps and make them explicit. They not only offer the possibility of verification but also instill a kind of discipline of higher performance."
"The knowledge exists. But however supremely specialized and trained we may have become, steps are still missed. Mistakes are still made...What do you do when expertise is not enough?"
"People can lull themselves into skipping steps even when they remember them."
"Charts and checklists, that's nursing stuff -- boring stuff. They are nothing that we doctors, with our extra years of training and specialization, would ever need or use."
"Some physicians were offended by the suggestion that they needed checklists."
"Checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized. They provide a kind of cognitive net. They catch mental flaws inherent in all of us - flaws of memory and attention and thoroughness. And because they do, they raise wide, unexpected possibilities."
"There seemed no field or profession where checklists might not help."
"People start shortcutting. Steps get missed. So you want to keep the list short by focusing on 'the killer items' - the steps that are most dangerous to skip and sometimes overlooked nonetheless."
"The success has been sustained for several years now -- all because of a stupid little checklist."
"You want people to make sure to get the stupid stuff right."
"They supply a set of checks to ensure the stupid but critical stuff is not overlooked."
"Checklists have proved their worth - they work."
"In a complex environment, experts are up against two main difficulties. The first is the fallibility of human memory and attention, especially when it comes to mundane, routine matters that are easily overlooked under the strain of more pressing events.
"Good checklists are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything. Instead, they provide reminders of only the most critical and important steps - the ones that even the highly skilled professionals using them could miss."
Change happens. All veterinarians at LSU SVM who provide hands-on care to animals owned by the public must be licensed as of October 1, 2016
Some GREAT news. I waited to post this until it was printed in the Louisiana Register. Beginning 10/1/2016, all veterinarians who work at LSU School of Veterinary Medicine and who provide hands on care to animals owned by the public must be LICENSED. This is new and this is great. Thanks to all who had anything to do with making this happen. My biggest thanks goes to my dear Hotstuff, who sacrificed the most. Please read below the very nice email from Mike Tomino, attorney for Louisiana Board of Veterinary Medicine. Also attached is the actual piece printed in the Louisiana Register that came out today. Hotstuff's sacrifice was not in vain. If you'd like to see for yourself, you can do so by clicking this link to the Louisiana Register and going to October 2015 and then go to pages 2151-2152.