Did my vet commit malpractice?

Hi Eric!!

I am currently staying with some family friends whose cat had thyroid surgery. The cat is a healthy 15-year-old. At the time, the vet said that other than minor risk from anesthesia, there would be no complications from such a procedure, and that she wouldnt have to take medicine.

Well, turns out the cat came back yesterday, and immediately got hypocalcemic, and had to be rushed to emergency. What theyre mad about is that the vet was very nonchalant about the possibility of anything bad happening from such a procedure, and are furious that they werent at least told about the potential risks of hypocalcemia based on the parathyroid glands being damaged (not really sure what Im talking about here).

Anyway, I thought Id help out by jumping online to see what others have to say, and I came across your blog almost immediately. Can you give me a vets perspective on this situation? How rare is this complication, and would most vet have told their clients as they told them about the pros and cons of thyroid surgery?

Thanks again a ton,

Sush

I won’t mince words. This is a very bad situation for the cat, for your friends, and possibly for the vet.

Hyperthyroidism is a common disease in older cats. It occurs when the thyroid gland, which is located in the neck, becomes overactive. It can cause weight loss, high blood pressure, heart problems, intestinal problems, skin problems and blindness.

Fortunately, hyperthyroidism is treatable. Three common treatments exist. Medication can be administered daily for life to reduce the thyroid gland’s output. This is the most commonly employed treatment.

The second common treatment is called radioiodine therapy. A special (radioactive) type of iodine is administered to the cat. The iodine concentrates in the thyroid gland and permanently reduces its activity. The procedure sounds scary but it has an excellent success rate and a very low incidence of complications. Many vets, including me, believe that this is the best currently available treatment option for most cats.

A final treatment option for hyperthyoidism is surgical removal of the thyroid gland–the treatment that your friends’ cat went through. Surgery has a good chance of permanently curing hyperthyroidism. But it carries the risk of a very serious complication: accidental removal of the parathyroid glands.

The parathyroid glands are located adjacent to the thyroid gland. In most cats they are microscopic. It is possible to remove the parathyroid glands accidentally during thyroid surgery.

Cats without parathyroid glands cannot properly regulate blood levels of calcium and phosphorus. This condition, called hypoparathyroidism, is difficult and expensive to treat. Untreated hypoparathyroidism generally is fatal.

Your friends are mad. Let’s address a question that no doubt is on some people’s minds by now. Did your friends’ vet commit malpractice?

I will say first that accidentally removing the parathyroid glands during surgery was not an act of malpractice. The complication can occur regardless of the surgeon’s skill level. Malpractice generally implies making a mistake that other vets would not have made. Any vet could accidentally remove the parathyroid glands during thyroid surgery. No malpractice there.

Did the vet commit malpractice by failing to discuss all available treatment options and the risk of surgical complications (including hypoparathyroidism) with your friends? I don’t know. For one thing, your friends’ recollection of the pre-surgical conversation may be different from the vet’s. Were your friends nervous about the surgery or distracted in any way during the conversation? In other words, is there any chance that the vet was not as nonchalant as they claim?

No malpractice occurred if the vet discussed the treatment options and potential complications in a manner that would enable most clients to make an informed treatment decision. My experience is that some very intelligent people simply don’t listen well while they’re with the vet. Every vet has been falsely accused of saying something he did not or failing to say something that he did.

However, I’m not saying that your friends are making this up. What if, as they claim, the vet did not adequately discuss all treatment options (particularly radioiodine therapy if it’s available in your area) and the potential complications of surgery?

I wouldn’t want to trade places with your friends’ vet in that case.