Pre-purchase examination2014

For one of two reasons:either You are new to the process of PPEs and need to attend

this course to become fully registered as a PPE vet

or You need to attend an update on the PPE process

every fifth year to re-register as a PPE vet

Why are you here?

Risk management◦ (how to become a harder target)

This is an evolving process influenced by:◦ unfortunate past experiences

◦ trying to be pro-active

What is the VPIS PPE Roadshow all about?

Dealing with a claim

How to give us, your insurer, the best chance of successfully defending the claim and making the whole situation less stressful for you

What to do and what not to do in the event of a claim

It’s also about

It is all about accuracy!

Attention to detail in:◦ Communication

◦ Performing all parts of the PPE examination

◦ Recording evidence of this process

◦ Reporting on the findings

How are we going to do this?

Anyone, if they are prepared to carry the entire financial consequence if things go wrong!

But if you require comprehensive insurance (and who wouldn’t!) you must:◦ have a current PPE insurance extension to your cover

◦ Follow the standard approved protocol for the examination (failure to do so = no cover)

◦ Use the correct paperwork (failure to do so = $15K excess)

Who can do a Pre-purchase examination

Performing any veterinary examination that influences a decision to buy a horse

This can masquerade as all types of request:◦ Just a “quick look” at the horse in general!◦ Check the heart and legs! ◦ Just a “basic vetting”◦ Do some quick flexions

What constitutes a PPE?

You cannot cut corners just because a horse is cheap!

We must perform our examination to a standardised benchmark level

We never know where a claim will come from

If the value of the horse doesn’t warrant an approved PPE examination, DON’T EXAMINE IT!

We cannot defend a self-styled examination

A full examination. This is the gold-standard comprising of stages 1 to 5

A partial examination which is often requested and comprises stages 1 and 2

Other specialised variations such as:◦ Yearlings ◦ Broodmares ◦ Polo ponies

The Pre-purchase examinationcan be:

We are going to have:◦ The pre-examination communication and paperwork.

◦ The examination and associated paperwork

◦ The reporting system and paperwork on the results of the examination

All are equally important, must be accurate and timely and can potentially trigger a claim

With the PPE process

Originally they were presented in the “Blue Book”

These days they are obtained from the discs made available in the proceedings of these “roadshows”

They are also available on the NZVA/VPIS websites

The templates for the paperwork – where do we find them?

We receive a request to examine a horse for purchase

It could be by phone, email, text or word-of-mouth

We need to find out about our purchaser, their experience and their expectations

Let the process begin!

We do this with the Receptionist’s Checklist This helps get a feel for

the purchaser, and their expectations

It gives us an idea of whether or not they need guiding through the PPE process

It is normal practice for potential purchasers to phone to book in a Pre-purchase examination. This

presents an opportunity to collect some of the information needed to plan the Pre-purchase

examination. A useful checklist sheet for the receptionist like the following example is optional and

can be used prior to veterinary contact: Purchaser’s name ...............................................................................................................................................

Fax number .........................................................................................................................................................

Phone number................................................... Best time to ring ..........................................................

New or existing client ..........................................................................................................................................

Ever had a Pre-purchase exam before? Yes No

Horse’s name ......................................................................................................................................................

Horse owner or stabled at ...................................................................................................................................

Horse’s age .........................................................................................................................................................

Horse will be used for .........................................................................................................................................

Have they seen or examined the horse? Yes No Has the horse been trialled/ridden? Yes No Do they know what type of examination they want? Yes No Do they need to discuss types of examination with vet? Yes No Do they know about ancillary tests e.g. scope, x-ray? Yes No Are x-rays required/contemplated? Yes No Are they able to be present at examination? Yes No Do they have any specific concerns about the horse? Yes No - if so ask them to note them for later discussion ...............................................................................................

Buyer’s statement faxed out Yes No Cost estimate requested Yes No

Time frame for examination and provision of written certificate .........................................................................

If computer/records show the seller is a client of the practice? THEN Has this potential purchaser been given the option of having another Veterinary practice

perform the PPE? Yes No

This must be signed by the buyer before the examination is commenced

It contains important legal disclaimers

Failure to have a correctly signed Buyer’s Statement will result in a $15,000 excess in the event of a claim

It is acceptable to customise the Buyer’s Statement by including prices, terms of payment etc but never alter or delete the legal disclaimers

Then we send out the BUYER’S STATEMENT

Version 1 – to be used if the vendor is not a client of the practice. This is a normal, uncomplicated request.

Version 2 – to be used when the vendor is a client of the practice being requested to perform a PPE◦ In this circumstance, the horse may have an existing medical

record with the practice

To not declare this could be interpreted as a potential CONFLICT OF INTEREST

There are two types of Buyer’s Statements

Buyers’ Statement – Version one Page 1 1. Buyer’s Statement (Version One)

VERSION ONE –

Version one of the Buyer’s Statement should be used in cases where the horse to be examined or the horse owner is not a client of the veterinary practice performing the pre-purchase examination.

1. BUYER’S STATEMENT I, .................................................................................................................................... (Buyer/Buyer’s Agent),

request that the horse ......................................................................... undergo a pre-purchase examination

for use as a ......................................................................................................................................................... This is to be undertaken by

Dr .................................................................................................................................................. (Veterinarian)

............................................................................................................................................................... (Practice)

The recipient of this report is deemed to be aware that if some stages of the standard procedure

recommended by the New Zealand Equine Veterinary Association are not carried out, any information or

opinion contained in this report is based on partial examination only. Some clinical signs of disease, injury or

abnormality that may have manifested themselves in the full five stage examination may not be apparent in

the restricted examination.

Where this examination and report are requested for the purpose of a business they are deemed to have

been carried out upon the basis that the examining veterinarian’s liability, howsoever arising, shall be no

greater than a sum equivalent to 100 times the fee charged for the provision of this report. In addition,

liability for consequential losses of any nature is also excluded.

This contract is governed by New Zealand law.

The Buyer/Buyer’s Agent irrevocably agrees that the Courts of New Zealand will have exclusive jurisdiction

to hear and determine all disputes under or in connection with this contract. The Buyer/Buyer’s Agent further

acknowledges that New Zealand is the forum conveniens for the hearing and determination for all disputes in

connection with this contract.

Ownership of X-rays: The Buyer/Buyer’s Agent acknowledges that any radiographs taken in the course of

this examination are the property of the veterinary practice listed herein, but it is further acknowledged by the

practice that copies of the radiographs will be supplied at the Buyer/Buyer’s Agent’s request and expense.

Reliance upon this report will constitute an acceptance of the limitations of liability referred to above.

In addition, the nature and extent of this report has been determined by particular request. In the

circumstances the examining veterinarian disclaims any liability whatsoever to any party other than the party

directly responsible for requesting and paying for the services rendered.

(a) Clinical Examination (which is carried out in five stages) Indicate with a tick please, either: ______ FULL EXAMINATION

Which includes:

Stage 1 Preliminary examination at rest

Stage 2 During walking, trotting, turning and backing

Stage 3 During and immediately after strenuous exercise

Stage 4 During period after exercise

Stage 5 During walking, trotting, turning and backing OR ______ PARTIAL EXAMINATION

Which includes:

Stage 1 Preliminary examination during rest

Stage 2 During walking, trotting, turning and backing The Clinical examination will be carried out substantially in accordance with the standard procedure

recommended by the Equine Branch of the NZ Veterinary Association (1997). (b) Ancillary Examinations Indicate with a tick please YES NO Endoscopy Blood test for anti inflammatory agents Radiography (tick areas to be radiographed):- front feet ( ) front fetlocks ( ) knees ( )

hind fetlocks ( ) hocks ( ) stifles ( ) Electrocardiography Reproductive Examination

Other ancillary examinations (please specify) ....................................................................................................

..............................................................................................................................................................................................

I understand the horse’s usual veterinary attendant is ................................................................. (Veterinarian)

.......................................................................................................................................................................... (Practice)

Terms of payment. I understand that I will be responsible for payment for the examinations

requested above.

Please note:- The certifying veterinarian takes no responsibility for, nor warrants the accuracy of, any

information provided in the owner’s statement including that given relating to the non-administration of

drugs, freedom from vices, existing performance or suitability for intended use.

Signature ......................................................................................................................................(Buyer/Buyer’s Agent) Date

Buyer’s Statement – Version two VERSION TWO –

This version of the Buyer’s Statement should be used in cases where the horse to be examined or the horse owner is a client of the veterinary practice performing the pre-purchase examination

1. BUYER’S STATEMENT I, .................................................................................................................................... (Buyer/Buyer’s Agent),

request that the horse ................................................................................................. undergo a pre-purchase

examination for use as a ............................................................................................. ........................................ This is to be undertaken by Dr ......................................................................... ................................... (Veterinarian)

.............................................................................................................................................................................. (Practice)

PLEASE NOTE: I am aware that the horse is owned by a person(s) that is/are or have been a client of

............................................................................................................................................................ (Practice)

I have been given the option of consulting with an independent practice and/or veterinarian but decline to do

so.

The owner(s) have waived the right to confidentiality in respect of the complete medical and/or treatment history held by or known to ............................................................................................................ (Practice)

In circumstances where ....................................................................................................................... (Practice)

has made all reasonable efforts to disclose to me all relevant information, I accept the practice cannot take

any responsibility for any lack of information. I also accept they cannot take responsibility for or guarantee

the accuracy or completeness of any information provided. I will not hold the practice or its employees,

directors or agents liable in any way in respect of the information obtained or not obtained in respect of the

horse’s medical and/or treatment history where reasonable efforts have been made by

............................................................................................................................................................... (Practice)

in this regard.

(Practice) .............................................................................................................................................................. is acting for me in this isolated instance and any information obtained or revealed during this examination is

confidential to me and will not be disclosed by the practice to the owner(s) or any other person without my

consent, which I have the free option of providing or not. The recipient of this report is deemed to be aware that if some stages of the standard procedure recommended by the New Zealand Equine Veterinary Association are not carried out, any information or opinion contained in this report is based on partial examination only. Some clinical signs of disease, injury or abnormality that may have manifested themselves in the full five stage examination may not be apparent in the restricted examination.

Where this examination and report are requested for the purpose of a business they are deemed to have been carried out upon the basis that the examining veterinarian’s liability, howsoever arising, shall be no greater than a sum equivalent to 100 times the fee charged for the provision of this report. In addition, liability for consequential losses of any nature is also excluded.

This contract is governed by New Zealand law.

The Buyer/Buyer’s Agent irrevocably agrees that the Courts of New Zealand will have exclusive jurisdiction to hear and determine all disputes under or in connection with this contract. The Buyer/Buyer’s Agent further acknowledges that New Zealand is the forum conveniens for the hearing and determination for all disputes in connection with this contract.

Ownership of X-rays: The Buyer/Buyer’s Agent acknowledges that any radiographs taken in the course of this examination are the property of the veterinary practice listed herein, but it is further acknowledged by the practice that copies of the radiographs will be supplied at the Buyer/Buyer’s Agent’s request and expense.

Reliance upon this report will constitute an acceptance of the limitations of liability referred to above.

In addition, the nature and extent of this report has been determined by particular request. In the circumstances the examining veterinarian disclaims any liability whatsoever to any party other than the party directly responsible for requesting and paying for the services rendered.

(a) Clinical Examination (which is carried out in five stages) Indicate with a tick please, either:

FULL EXAMINATION

Which includes:

Stage 1 Preliminary examination at rest

Stage 2 During walking, trotting, turning and backing

Stage 3 During and immediately after strenuous exercise

Stage 4 During period after exercise

Stage 5 During walking, trotting, turning and backing OR

PARTIAL EXAMINATION

Which includes:

Stage 1 Preliminary examination during rest

Stage 2 During walking, trotting, turning and backing The Clinical examination will be carried out substantially in accordance with the standard procedure recommended by the Equine Branch of the NZ Veterinary Association (1997). (b) Ancillary Examinations Indicate with a tick please YES NO Endoscopy Blood test for anti inflammatories Radigraphy

(tick areas to be radiographed):- front feet ( ) front fetlocks ( ) knees ( )

hind fetlocks ( ) hocks ( ) stifles ( ) Electrocardiography Reproductive Examination

Other ancillary examinations (please specify) ....................................................................................................

.............................................................................................................................................................................................. ......................

I understand the horse’s usual veterinary attendant is ................................................................. (Veterinarian)

........................................................................................................................................................................... (Practice)

Terms of payment. I understand that I will be responsible for payment for the examinations

requested above.

Please note:- The certifying veterinarian takes no responsibility for, nor warrants the accuracy of, any

information provided in the owner’s statement including that given relating to the non-administration of

drugs, freedom from vices, existing performance or suitability for intended use.

Signature ......................................................................................................................................(Buyer/Buyer’s Agent) Date …………………………………………………………

There is an international precedent for this “conflict of interest” situation. It has been established overseas.

The purchaser MUST know that this potential conflict exists.

They must be given the option to appoint an independent vet.

If they still persist with you as their choice of examining vet, they must sign off on a series of disclaimers included on the Version 2 Statement.

What is the significance of the Version 2 Buyer’s Statement?

Your responsibilities with the Version 2 request Ensure that your staff

understands the significance of the different forms and sends out the correct one!

Check the horse’s medical records in the clinic, this is recorded on the Conflict Check Worksheet

CONFLICT CHECK WORKSHEET

(for Pre-purchase examination of a horse where this horse/vendor is an existing practice client) Purchaser’s name ...............................................................................................................................................

Vendor’s name ....................................................................................................................................................

Phone number ................................................... mobile ...........................................................................

Horse's Name ......................................................................................................................................................

PPE Veterinarian ................................................................................................................................................................

STEPS TAKEN TO DETERMINE IF PRACTICE HAS RELEVANT INFORMATION

Computer records Yes No

Veterinarians questioned Yes No

DO WE HAVE A PREVIOUS MEDICAL RECORD ON THIS HORSE?

Yes No

if yes

has PPE veterinarian been made aware? Yes No

This: Allows you to release this

information to the purchaser without breaching our professional code of conduct which prohibits disclosure of such information

It provides written acknowledgement of permission to do this

It protects us from possible repercussions by the VCNZ

If there is no history, perform the PPE as though it was originated by a Version 1 request

If there is a history, you must ensure that the vendor is prepared to, and does, sign a Waiver of Information

Page 1 Waiver of Information

WAIVER OF INFORMATION – TO BE SIGNED BY VENDOR(S)

Waiver by owner(s)/owners duly authorised agent in respect of confidential information:

I ____________________________________________________ (owner/owner’s duly authorised agent) agree that ____________________________________________________ [name of veterinary practice] (“the practice”) is authorised to obtain and disclose the complete medical and/or treatment history of _______________________________________________ [name of horse] (‘the horse”) held or otherwise known by the practice to: _________________________________________________________________ (name of potential purchaser).

I am aware I am waiving my right to confidentiality and privacy in terms of clause 6.1 of the Veterinary

Code of Conduct (or equivalent in subsequent codes) and/or contract and/or common law and that

the practice has no control over or responsibility for how that information is used or disclosed once

disclosure has been made.

I am aware that the practice is, in this isolated instance, acting on behalf of the potential purchaser of

the horse and that the practice will be examining the horse at the potential purchaser’s request. Any

information obtained or revealed during this examination is confidential to the potential purchaser and

will not be disclosed to me without the potential purchaser’s consent, which may or may not be

obtained, at the sole discretion of the potential purchaser.

I will not hold the practice or its employees, directors or agents liable in any way in respect of the

potential purchaser’s decision to purchase or not to purchase the horse.

Signed by ________________________________________ (signature)

Name: ___________________________________________ (print)

On _________________________ (date) at _____________________________ (place)

Anything from the horse’s records that is relevant to, or may adversely affect, the PPE

This includes:◦ Surgery, illness

◦ Lameness examinations

◦ Joint injections

What is a significant “medical history”?

We have contact with:◦ The buyer

◦ The vendor

Paperwork that may be required from them:◦ Buyer Buyer’s Statement

Blood test form ◦ Vendor Owner’s Statement

The Version 2 Waiver

Who are we dealing with when requested to perform a PPE?

Communication with the buyer is VERY important

We need to know:◦ The experience of the buyer

◦ The expectations of the buyer

◦ That they understand that a PPE is not a warranty

The buyer needs to know

◦ The cost of the examination

◦ The time-frame for the examination

◦ Answers to topics raised in the “checklists”

The Buyer

Decisions the buyer needs to make:◦ The extent of the examination (stage 1-2 or 1-5)

◦ What exercise is appropriate?

◦ What auxiliary diagnostic tests are required (X-rays, endoscopy etc?)

◦ Blood tests for NSAIDs?

◦ What feedback is required if adverse findings emerge during the examination? Should the examination cease if a problem is found?

The Buyer

A request for a blood test is an option on the Buyer’s Statement

It is important for everyone to know that:◦ We will only test for NSAIDs

◦ We will not store blood samples. Samples must be sent immediately for testing or not at all

◦ An agreement explaining the limitations of the process must be signed by the buyer

◦ The test requires the collection of four heparin tubes

Blood testing as part of a PPE

Blood analysis as part of the Pre-Purchase Examination

If the Buyer/Buyer's agent requires blood samples to be extracted and tested, the following provisions will apply:

1. The blood will be extracted at the time of the PPE and immediately analysed by the examining

veterinarian(s) and/or the practice and/or its third party agent;

2. Blood will be tested for Non steroidal anti inflammatory agents (NSAID) ONLY;

3. Results of the blood analysis will be passed on to the Buyer/Buyer's agent in writing;

4. The Buyer acknowledges that after analysis has occurred the blood samples will not be stored by

any party and will be destroyed and not available at a later stage;

5. The cost for the blood testing and analysis is $............................in addition to the cost of the PPE

and other ancillary examinations;

6. The veterinarian and/or the practice will not be liable for any loss or harm caused by the

extraction or analysis procedure, whether under contract, negligence, equity, tort or otherwise;

I acknowledge that I have read and am bound by the above provisions:

_______________________________________________

(Signed by or on behalf of the Buyer/Buyer's agent)

Name: ___________________________________________(print)

On _________________________ (date) at _____________________________ (place)

Time invested in contact and building goodwill with the vendor before the PPE is time well spent!

Be courteous Arrange a suitable time and place for the examination

The Vendor

The extent of the examination requested The time needed for the examination Availability of a rider/driver Whether suitable areas are available for:

◦ The examination

◦ Exercise

◦ Diagnostic tests (e.g. power for radiography)

Is it permissible to administer sedation? Can the shoes be removed?

The Vendor – topics to be discussed

Get the vendor/attendant to fill this out at the time of the examination

Get it filled out in the vendor’s own hand writing If no-one is available to fill this out – Note it on the

report e.g. the horse was on trial with the purchaser Resist the temptation to “help the vendor out with the

statement by “putting words into their mouths”

The Owner’s Statement

Expand on questions asked to make their meaning clearer and more relevant e.g. “by drugs, I mean Ese, hormones, long-acting sedatives etc.”

Read the comments on the Owner’s Statement carefully Ask any questions about comments made Probe further if necessary

While the mechanics of the full PPE technique is outside the scope of this Roadshow, it is important to stress that the standard, prescribed examination process should be followed

These steps along with relevant findings should be recorded on the standard Veterinarian’s Examination Record

The examination

The completed report comprises of three important parts. All must be completed and included or available:

◦ Part 1 - The Buyer’s Statement

◦ Part 2 - The Owner’s Statement

◦ Part 3 - The Veterinary Certificate

Reporting on a PPE

Often the only part the purchaser sees

Use –

standard report format and all disclaimers

Complete list of findings must be recorded

Limit comments to clinical findings only

Be professional –

use clear concise language

Quote authoritative texts

Make the report professional looking

The Report

Use a word processor Follow the template pattern – it is OK to personalise

with letterheads etc. Remove parts of the examination not performed from

the documentation Use plenty of space Include digital pictures if required

Writing the Report

Any problems with this Certificate??

The Report – appearance is importantIt is the only impression the purchaser has of the quality of your work

SND NO:896 XXXXX/XXXXX

Veterinary Clinical Findings and Opinion thereof:- At the time of examination, the following observations were made:-

The gelding was presented in good physical condition and was tractable throughout the examination. The history was presented by Mr XXXXX (trainer). He had been associated with the horse for two years

and nothing of significance was noted in the history. A small skin lump (approximately 1 cm in diameter) was present just above the tail on the midline. This

is most likely to be an epidermal inclusion cyst and is of low probable risk. The horse worked over 2000m on the dirt, the last 600m at speed. He moved freely with no sign of

lameness or respiratory noise. Radiographic Examination Radiographs taken and read by Dr XXXXXX BVSc

Radiograph projections taken:-

Radiographs taken and read by Dr XXXXXXX BVSc

Radiograph projections taken:-

Left fore and right fore feet: D60Pr-PaDiOb (pedal and navicular views), Lateral.

Left fore and right fore fetlock: DP, D55L-PaMO, D55M-PaLO, Flexed lateral.

Left and right carpus: DP, D55L-PaMO, D70M-PaLO, Flexed lateral, Flexed DPr-DdiOb of Distal row.

Left hind and right hind fetlock: DP, D55L-PLMO, D55M-PLLO, Lateral.

Left and right hock: D10L-PLMO, D45L-PLMO, Lateral, D65M-PLLO.

Left and right stifle: Lateral standing, caudo-cranial. Radiographic Findings and Opinion thereof:-

Very minor remodelling was noted on the proximal intermediate carpal bone in the left carpus. This was not associated with any clinical signs and is of low probable risk.

The right pedal bone had a slightly asymmetrical distal notch. This was smooth margined and is of no clinical significance.

Endoscopic Examination Findings of the Upper Respiratory Tract and Opinion thereof:- Endoscopic examinations were performed before and after exercise and these revealed no abnormalities. The horse had a Grade 1 larynx (on the Lane grading system). Other Ancillary Examination Findings and Opinion thereof:- An ultrasound examination of the flexor tendons, suspensory ligaments and their branches in the front legs revealed no abnormalities. A blood sample was submitted for NSAIDs to New Zealand Racing Laboratory Ltd, results pending. Within the limits of the examination, no abnormality that may significantly affect the horse's future suitability for racing has been detected and I believe this horse meets the requirements of the Hong Kong Jockey Club for suitability for importation into Hong Kong.

Each page should be clearly identified All pages should be numbered Some vets have been initialling each page

PPE Format - Security

Do not use the words: sound, serviceable, satisfactory for

Note any omissions or exam restrictions Note any other useful diagnostic procedures that could

be used to clarify an issue particularly if has been declined!

Limit the time frame of the report (date & time) Ensure statements are legally defensible

Wording of reports

Hong Kong requires the wording: “Within the limits of the examination, no abnormalities that may

significantly affect this horse’s future suitability for racing have been detected and I believe this horse meets the requirements of the Hong Kong Jockey Club for suitability for importation into Hong Kong”

The MRA provide their own certificate and require it to be filled out. In it the conclusion requires a statement: “Within the limits of the examination, the horse has been found

suitable for racing purposes”

Exceptions for use of specified wording

This requires: Requires commitment from vets Requires training for support staff Resist cutting corners under pressure System of double checking everything

How do we keep up our standards and avoid mistakes?

VPIS has developed a process of risk management (PPE roadshows, regular updating of templates etc.)

VPIS annually checks an example of a PPE report from every practice and gives feedback to the practice

What are the biggest problems?

Most practices are very good Direct use of template without deleting areas not used gives

a very untidy appearance Use of an out of date report template Poor selection of words e.g. “sound” “serviceable”

How do we maintain and monitor quality of paperwork?

Variations in pre-purchase examinations

Different types of horses

Thoroughbred Racehorses

Standard Examination endoscopy

electrocardiography

radiography

Stage 3 exercise type

distance

speed

Thoroughbred - Asian protocols

Macau

Malaysia

Singapore

Hong Kong

Standardbred Racehorses

Standard Examination conformation hock

forelimb “toe-in”

“knee Knocker”

shoeing

accurate record

Extra gear used

Showjumpers

Standard Examination Radiography

pre-existing problems

vs Schoolmastervs Performance

Eventers

Standard Examination endoscopy

pre-existing problems especially with thoroughbreds and prior racing injuries

Polo Ponies

Standard Exam

BEWARE! abbreviated

“polo soundness”

Dressage

Standard Examination

BEWARE! lameness disguised by over-

collection during exercise

Be wary of unreasonable expectations of what we can detect

Western Horses

Standard Exam radiography

Endurance

Standard Examination exercise - very important

lifetime log book

Yearling Sales

Pre-purchase exam is restricted because of the environment and constraints at sales

All parties aware need to be aware of these constraints

records

conformation

testes descent

endoscopy – post-sale

Radiography – pre-sale

Ponies

Standard Examination issues

height

cost knowledge of PPE

is an opportunity to develop new clients

VPIS Prepurchase examination

Insurance and legal aspects

Current trends Society increasingly litigious

Professional indemnity claims are a reality in equine work

Pre-purchase exams are always a significant proportion of equine claims

The numbers of PPE claims are decreasing BUT the value of individual claims is increasing

The quality of PPE work and reporting has improved

There is input from both NZVA and VPIS Vets require a PPE extension (around 80 vets) We have a published standard (the “Blue Book”) We run roadshows and seminars We give as much feedback as possible through

newsletters and conferences Quality Control – sample PPE reports assessed

annually. Radiographs to H/K reviewed VPIS have a very good lawyer

How we manage risk

Claims – what eventually happens? “begin with the end in mind”

Nothing – 40% claims do not proceed

Negotiation – 20% legitimate claims

Defended – 40% debatable claim- claimant pursues case

- claim usually fails- costs can be high

Claims – the start

• Claim arrives - personal/legal

- rumour/request

- verbal/written

• Do not advise you are insured - but say yes if asked

• Never suggest client makes claim• Contact insurer immediately• Have no discussion with purchaser/lawyer

How do we handle a claim?

• The claim needs to be assessedUse: – equine clinician

- specialist 2nd opinion - legal opinion

• After assessment develop a plan Actions: – do nothing

- defend - negotiate

What does the vet do with a potential claim? Hand the matter immediately and completely over to

insurers – the benefit of paying a premium

Get on with your life

- do not get emotionally involved

Claims often drag on for years

Claim Prevention - Summary

1. Initially establish who is purchaser?

2. Avoid any conflict of interest (Is the vendor a client?)

Disclose any conflict before starting a PPE Use the Version 2 of Buyer’s Statement Do the Conflict Check

3. Use VPIS NZEVA standard paperwork The current version (it is available on the VPIS website)

PPE claim prevention

4. Limit liability Have one named person (purchaser) on the paperwork Specify a date and time for the examination Perform the prescribed examination as defined by the

Buyer’s Statement Obtain an accurate Owner’s Statement for historical

information Obtain a Waiver of Information for Version 2

5. Note any special circumstances No darkened box for eye exam Windy wet day, handler useless

PPE claim prevention

6. Use Vet Worksheet during exam Record an accurate ID of horse Avoid missing parts of exam Ensure all findings are recorded

7. Comment only on clinical findings Never on suitability or “soundness” Quote reference texts if appropriate

PPE claim prevention

8. Perform radiology to the highest standard Eye to detail with technique & interpretation Use a second opinion if there is any doubt in your

radiographic interpretation.

9. Do not delete any Conditions or Disclaimers

PPE claim prevention

10. Learn to recognise trouble early!! Post PPE request for radiographs Gossip at the track/pony club

11. Document all contact with purchaser Especially post-PPE Don’t discuss claim with purchaser/lawyer

12. File in retrievable way – 7 years

VPIS

PPE Claims examples

The following claims have occurred in the last 2 years

July 2014

Case 1. Showjumper 3-year-old unbroken gelding

Case 1 – claim details Partial PPE was performed & horse sold Horse was broken in and training started Possible “uneveness” noted by purchaser Muscle ‘indent’ noted caudolateral thigh Purchaser’s vet examined and described unusual

hindlimb gait and questioned indent as a cause PPE vet receives a lawyer’s letter citing negligence

Case 1 - claim

Claim for $25,000

Case 1 - workup

Horse sent for expert examination of the muscle indent

No lameness found, ultrasound examination found no indication of loss of function

Breeder conducted examination of 18 horses on their property; 6 had indents

Case 1 - issues

Thoroughness of PPE Examination Was limited due to horse being unbroken Indent was noticed but not noted in report

Purchaser’s veterinary examination Technique for the examination is unknown Interpretation of the results was questionable The subsequent certificate poorly written and inflamed the

situation

Case 1 – result

Claim rejected

Case 1 – lessons to be learnt

Take care if asked to investigate and report on a PPE issue as it could impact on a colleague – peer review!

Note EVERYTHING in your PPE report

Case 2. An 8-year-old TB mare

Case 2 - claim details

Partial PPE was performed & horse sold 1 Week after PPE, horse shows lameness Examined by purchaser’s vets: X-rays and blocks were

performed Purchaser contacts vendor; differences unresolved PPE vet examines purchaser’s vets X-rays on behalf of

vendor Purchaser takes vendor to disputes tribunal

Case 2 - claim

Disputes tribunal found in favour of the vendor Purchaser wrote to PPE vet – mostly unhappy with poor

communication and issues of conflict

Case 2 - issues

PPE Examination

Horse was not lunged!!!

Vendor was present at PPE examination; some aspects that were discussed were not mentioned in the report

Be very careful for WHOM you act – there was a conflict when PPE vet acted for vendor

Case 2 – result Remedial shoeing was advised

Horse is still with the owner

Case 3. 8-year-old Thoroughbred eventer

Case 3 – claim details

Full PPE, forelimb X-rays and front leg ultrasound examinations were performed

Horse was exported to USA and competes 3 months after PPE it develops suspensory branch

desmitis US veterinary examination considers suspensory

branch lesion ‘chronic’

Case 3 - claim

Claim for $50,000.

Case 3 - issues

PPE Examination Thorough: lunged and observed jumping X-rays show some sesamoiditis in opposite leg Ultrasound images of suspensory branches had not been

recorded and retained

No clinical evidence of branch desmitis was seen at the PPE

Horse was owned by a vet

Case 3 - lessons

Can ultrasound lesions be aged? These things happen; the horse was in heavy work after

its arrival in USA

Case 3 – result Case is still unresolved; no more lawyers’ letters PPE was performed in 2010

July 2014