The dilemma: Helpful assistance or grounds for dismissal?
Dr. Marc Rosenberg is the director of the Voorhees Veterinary Center in Voorhees, New Jersey.Growing up in a veterinary family, he was inspired to join the profession because his father was a small animal practitioner. Dr. Rosenberg has two dogs and three cats.In Dr. Rosenbergs private time, he enjoys playing basketball and swing dancing with his wifethey have danced all over the world, including New York City, Paris and Tokyo. Dr. Rosenberg has been a member of the Screen Actors Guild and the American Federation of Television and Radio Actors for more than 30 years. He has hosted two radio shows, a national TV show and appeared in over 30 national TV commercials, all with pet care themes.
Regardless of the intention, it is never OK for a veterinary technician to sign off on a medical order on behalf of a veterinarian.
Peaceable Pet Care has always been a busy veterinary practice. But after months of what they dubbed the “coronavirus crush,” staff stress was palpable, and the role of the clinic’s veterinary technicians had increased measurably. For increased practice efficiency and prompt patient care, clinic staff had to work as a team—not an easy task because curbside waiting rooms were now the size of a tennis court, and phone lines were jammed due to clients not being allowed in the facility. These and other factors led to shortcuts that were intended to increase efficiency and improve service but not endanger patient health.
One way the practice increased efficiency was to increase the number of technician visits, in which a technician administered treatments to patients that had recently been seen by a staff veterinarian or were undergoing a long-term prescribed treatment protocol. For example, these visits included administering the second in a series of vaccines or routine administration of chronic injectable medications.
But one recent technician appointment may have pushed the envelope a bit too far. Whiskers, a 9-year-old cat, was presented to the clinic for its monthly appointment for chronic Irritable bowel disease. The doctor had ordered a vitamin B12 injection and a methylprednisolone injection as a monthly technician visit with a recheck by the veterinarian every 3 months. The doctor’s notes indicated a dose of 0.8 mL of methylprednisolone for the first 2 months, followed by 1.8 mL in the third month. Janet, the technician assigned to this case, saw these notes in the record and assumed the doctor had accidentally entered 1.8 mL instead of 0.8 mL. After recalculating the dose for the pet’s weight, Janet corrected the notes and gave the cat its usual 0.8-mL dose. She signed off on the notes and the change using the prescribing veterinarian’s name rather than her own. In an unrelated case, Janet renewed a patient’s prescription after reviewing the medical record and signed the doctor’s name to the order because the doctor was off duty when the request for renewal was made.
When the attending veterinarian reviewed her patient notes, she came across a renewal order under her signature. She didn’t recall approving this renewal and brought it to the attention of the clinic’s medical director. Through the hospital’s record keeping software, the medical director was able to identify the time, date, and workstation of the specific entry, which led back to Janet. Although no harm came of renewing the prescription or administering the wrong dose—except that the patient that received the incorrect methylprednisolone dose would have to return to the clinic—the fact remained that doctor’s signature was electronically forged on these records.
The medical director scheduled a meeting with Janet and asked her about these medical entries. Janet responded that she acted only in the name of efficiency and believed she was assisting patients in need. She thought the doctor should appreciate her efforts. The medical director explained that behind a veterinarian’s signature are a license, laws, and strict accountability. Although no harm came to the patients involved, every staff member must sign recorded entries honestly and accurately.
The question arose as to whether Janet’s actions were grounds for termination of an otherwise excellent technician. Following consultation with the veterinarian involved, the medical director determined that Janet would remain employed by the clinic if she agreed never to do this again and apologize to the veterinarian involved. In addition, the incidents would be noted in Janet’s personnel file. The medical director stood by what she believed was a very difficult decision.
Do you agree with the medical director’s decision? How would you have handled the situation? Let us know your thoughts by emailing firstname.lastname@example.org.
There is a cliché about not throwing the baby out with the bathwater. Some might argue that it is more difficult to find excellent veterinary technicians than it is to find excellent veterinarians.
That said, forging a doctor’s name on patient medical records is a very serious offense, regardless of the intent. In this case, the technician was not pursuing any personal gain whatsoever; she was simply inappropriately expedient. Part of the responsibility also may have been with staff indoctrination training concerning the handling and sanctity of medical record keeping.
Honest, ethical behavior is the linchpin of a successful veterinary practice. When this behavior is breached, the consequences must be assessed seriously. I am going to go on record saying that I agree with the decision.
Marc Rosenberg, VMD, is director of Voorhees Veterinary Center in Voorhees, New Jersey. Although many of the scenarios Rosenberg describes in his column are based on real-life events, the veterinary practices, doctors, and employees described are fictional.