UC Davis Bad Vet
Recordkeeping
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Recordkeeping regulations are in place for many extremely important reasons:

1)     To ensure that when your pet goes home and goes back under the care of your hometown veterinarian, your hometown veterinarian will know what was done and be able to continue your pet’s care seamlessly.  Not knowing the specifics of the care at UCD VMTH could put your pet at risk.

2)   Written records are the only reliable way to ascertain what actually occurred.  Doctors do not remember what they said to you or how your pet was cared for 5 years ago. 

3)   Recordkeeping is required to protect the pet guardian should there be negligence or malpractice in the care of your pet. 

4)   Without rules for recordkeeping, UCD VMTH can write anything they want in the record, or nothing at all.  UCD VMTH can claim they provided services they did not provide or claim you agreed to services you did not agree to.  In our case, Sally’s records for her first five days at UCD VMTH were written by a doctor who did not treat Sally or speak to us during that time.  How could this doctor who signed the record possibly know what the treating doctor actually told us or what we told him?  Sally’s discharge papers stated they performed a surgery to biopsy Sally’s tumor, and that we agreed to it.  We had specifically denied consent for surgery to biopsy and consented instead only to surgery to remove the tumor on the advice of our hometown veterinarian.  None of that was in the record.

 

Any other veterinarian in California, outside of the UC system, who is proven to have altered a patient record in similar circumstances would be subject to disciplinary action by the California Veterinary Medical Board under the auspices of the California Department of Consumer Affairs. Disciplinary action could include suspension of license, revocation of license, civil damages and perhaps even criminal charges.