Guelph, Ont.The appointment was scheduled for the middle of a weekday, in the kind of strip-mall veterinary clinic that the country has, in the last fifteen years, allowed to multiply faster than it has allowed any other category of small medical business. The dog was a small dog, of a breed the country considers a family breed, of an age the country considers middle. The dog's owner, a woman in her sixties who has been keeping pets since before this magazine was founded, had taken the dog in for what the appointment slip described as a routine vaccination. The visit, by every available signal at the front desk, was supposed to take eighteen minutes.

The visit, by the records the clinic later released, took six hours. Two of those hours, somewhere in the middle, were spent draining fluid. The fluid was not, by any reading of the clinic's own notes, fluid that a small dog of that age and breed and weight should have been carrying. The owner was told, by the attending veterinarian, that the dog had had an unusual reaction to the vaccine. The owner was told the dog would be fine. The dog, by the next morning, was alive. The records, when the owner requested them, were not what the owner had expected.

The protocol

The Canadian Veterinary Medical Association publishes a standard of care for vaccine reactions. The standard, distilled, requires the attending clinician to document the reaction at the time it presents, to record the intervention, to record the patient's vitals at intervals through the intervention, to record the dose and administration of any medication used to manage the reaction, and to make the entirety of that record available to the owner on request. The standard is not optional. The standard is what distinguishes a veterinary clinic from a back-room operation.

The record the owner received contained none of these things in the order or with the detail the standard requires. Vitals were recorded at the start of the appointment and again at the end. The intervening four-and-a-half hours, the period in which two litres of fluid were drained from a small dog, were represented by a single line that read, in part, "patient stabilised after observation." The medication used to manage the reaction was not specified by dose. The route of administration was not specified at all. The clinician's signature appeared once, at the bottom, against a timestamp that did not match either of the two vital-sign entries.

The request

The owner, on the advice of a friend who is a registered nurse, wrote to the clinic and asked for the complete medical record, including all notes, the inventory log entries for any medications used, the equipment log for the procedure room during the relevant interval, and the names and credentials of every person who had touched the dog. The clinic produced, after a delay of three weeks and one written reminder, a four-page document that did not include the inventory log, did not include the equipment log, and did not include the names of two of the four people the owner could remember seeing in the room. When the owner pointed this out, in writing, the clinic responded that the additional records "are not part of the patient file in the ordinary sense and would require a formal release."

This is not what the College's published standard says. The College's published standard says that the patient file includes any record reasonably necessary for the owner or a subsequent practitioner to understand the care that was provided. An inventory log of medications drawn from the clinic's own controlled-drug cabinet during the procedure is, on any honest reading, reasonably necessary. An equipment log of who handled which piece of monitoring equipment is, on any honest reading, reasonably necessary. The clinic has, in withholding both, departed from the standard. The College, when contacted by this magazine, declined to comment on the specific file.

A clinic that cannot, on request, produce the inventory log for the medications it used on a patient is a clinic operating below the floor of its profession.

What the country's regulator is for

The College of Veterinarians of Ontario is the body the province has empowered to inspect, audit, and discipline veterinary clinics. The College's inspection schedule, in its most recent annual report, contemplates a routine inspection of each licensed facility on a rolling cycle, the period of which is not, in any document this magazine has been able to find, publicly disclosed in plain language. The cycle, in practice, appears to be longer than five years for the average clinic. The complaint mechanism, when invoked, is slow. The complainant, in the meantime, is the owner of a small dog whose medical record has gaps.

What a regulator is for, in any honest reading of what regulators do in other parts of the country's professional landscape, is to remove this kind of asymmetry. The asymmetry is that the clinic has the records, the College has the authority to compel them, and the owner, who paid for the visit, watched the dog suffer the reaction, and bears the cost of the next eighteen months of monitoring the dog's recovery, has neither. The owner, in this magazine's view, ought not to be the party left holding the half-record.

The cover, examined

This magazine is careful with the word cover-up. It is a strong phrase and it requires evidence. What this magazine can say, on the documentary record now in counsel's possession, is the following. The clinic produced a record. The record omitted material the College's own standard requires. When the omission was identified, the clinic offered a procedural reason for the omission that is not consistent with the College's standard. The reason offered would, if accepted as policy, allow any clinic in any contested matter to withhold the inventory log of the medications it used. That is not an accident. That is a position. The position serves the clinic and disserves the patient. Whether it constitutes a cover-up in the legal sense will be determined, in the ordinary course, by the College, by a civil claim, or by both.

The dog, in the meantime, is recovering. The owner is keeping a separate log, in pencil, of the dog's appetite, weight, and behaviour, in a notebook the dog sometimes sleeps on. The notebook is more complete than the clinic's record. The notebook is also, by every legal definition the country uses, not a medical record. The country has, in this small file, asked the wrong party to do the documentation. The country, as a rule, asks the wrong party.

A short request to the College

Publish, in plain language, the inspection cycle for veterinary clinics in this province. Publish, in plain language, the median time from complaint to resolution. Publish, in plain language, the threshold of incompleteness in a medical record at which the College's own standard is considered breached. The owner of a small dog should not have to write to a magazine to learn what the country has already, on its own letterhead, undertaken to provide.

The dog, on a recent morning, was eating again. The owner has not, at the time of writing, decided whether to file the formal complaint. The clinic has, at the time of writing, not produced the inventory log. This magazine intends, in the next issue, to ask again.