Avoiding Conflicts of Interest in Purchase Exams

At the recent American Association of Equine Practitioners Annual Convention in Nashville, several questions regarding potential conflicts of interest when conducting a purchase exam were posed to the Professional Conduct and Ethics Committee, which I chair. I hope a summary of the discussion will be useful to both buyers and sellers, and shed some insight on the veterinarian’s perspective.

The most common potential conflict we encounter in practice is one in which both the buyer and seller are clients of the examiner’s practice. In the past, many have stated that one should not perform such an examination, and this is certainly one option. However, in many cases, neither the buyer nor seller object to such and are comfortable with a veterinarian performing the exam. This requires that there is full disclosure to all parties with whom you have a relationship, and that there is full disclosure of all medical records and history of the animal by the seller. In my opinion, under these circumstances, the potential conflict can be avoided and all parties are served. One should always document such potential conflicts and have all parties sign off on such. When a situation arises in which there is not full disclosure of all medical history, a veterinarians should walk away from the exam and advise the buyer politely that there is a potential conflict of interest and suggest another practice conduct the exam.

images DR footOne question put to the committee concerned basing the fee for the exam on a percentage of the purchase price if the buyer does buy the horse. This is a clear conflict of interest and has great potential to influence the interpretation of the findings in favor of the seller. Many very expensive animals are examined by veterinarians daily and require thorough workups. Veterinarians should be paid a just fee for these exams, but our fee should never be tied to whether a sale goes through.

The following statement from Harry Werner, VMD, effectively sums up these conflicts:

“Potential conflicts of interest, real or perceived, commonly present ethical challenges to performance of prepurchase examinations. Historically, this issue was addressed with a simple and short list of circumstances under which it was recommended that an equine practitioner decline to perform the examination. In reality, while some relationships clearly do represent a conflict, others do not or can be indemnified from such criticism by timely and full disclosure to all parties.

Few would question that the veterinarian should decline performing the examination if he/she owns any equity interest in the horse or stands to gain monetarily from the outcome of the sale. However, an oft-repeated admonition over the years has been to avoid examining any horse when the examiner has a ‘professional relationship’ with the seller or agents of the seller. This, in the opinion of many, is an unrealistic and unnecessary prohibition. In fact, a strong case can be made that the examiner with firsthand knowledge of the horse brings added value to the buyer, providing that the seller authorizes full disclosure of the medical history. Additionally, many times the buyer’s veterinarian also serves the seller in the same form and the buyer clearly expresses that he/she prefers this veterinarians perform the examination. It is my opinion that the answer to the ‘conflict of interest dilemma’ lies in full disclosure of the horse’s medical history and the examiner’s relationship with the seller and the horse to all parties.”

Dr. Werner’s statement is a good working document for all veterinarians conducting prepurchase exams. However, if one suspects that full disclosure is not going to prevent a conflict, then all parties are better served by the practitioner recusing themselves and advising the purchaser on the selection of another veterinarian.

Equine Enteric Coronavirus – A Newly Emerging Disease Of Horses

Cornell University’s School of Veterinary Medicine has provided current information on Equine Enteric Coronavirus, a newly emerging disease most often found in the Northeast during colder seasons.  Good information to keep in mind as you monitor your horse’s health this winter.

As always, please feel free to call us with any questions or concerns about your horse’s health:  (434)973-7947 Earlysville Clinic or (540)460-5702 Valley Division.

Choking In Horses

It can be a very scary thing when a horse chokes, but if you know what to do when it happens, it can make the problem resolve faster with fewer complications.  A horse chokes when grain, hay, or other substances get lodged in the esophagus and will not pass. The esophagus is a muscular tube that takes food, water, and other substances from the mouth to the stomach. Since a choke involves the esophagus and not the trachea (windpipe), the horse can still breathe, but it can cause symptoms such as nasal discharge, stretching of the neck usually in a downward direction, increased salivation, coughing, difficulty swallowing, and/or lack of appetite. Sometimes a choke can also cause aspiration pneumonia, where material passes down the trachea and into the lungs.

Choking can be caused by many things. such as dry feed, horses that eat too fast, a foreign body, and/or dental problems that would cause the horse not to chew its food properly.

If you suspect choke with a horse, the first step is to call your veterinarian and proceed with their directions. While waiting for the veterinarian, you should remove any feed that was offered to keep the blockage from becoming worse and prepare a bucket of lukewarm water. Once the veterinarian arrives, he/she will assess the severity of the choke and proceed with giving a sedative, medication to help the esophagus relax, and/or pass a tube down the esophagus. Sometimes the sedative and other medications will relax the esophagus enough to allow the blocked food to pass on its own, but in many cases, a tube needs to be passed. The veterinarian will pass the tube down the nose and follow the esophagus to the block. With water, they will gently lavage around the blockage to loosen up the material. In most cases, this will dislodge the material and the choke will be resolved. There are some situations where the blockage cannot be fixed this way and more involved procedures need to be used, such as full sedation or surgery, although this is rare.

Round bale feederOnce the choke has resolved and if the horse has been sedated, you should not feed them until they are fully awake. You may be instructed soften the horses feed for a few days to let the esophagus heal. To prevent future chokes you should:

* Make sure your veterinarian has checked the horse’s teeth for any abnormalities on a regular basis (every 6-12 month)

*Always provide clean/fresh water

*If changing feeds, do it gradually

*Cut any apples, carrots or other treats into small pieces

*Soak dry food adequately before feeding

*Slow down a horse that eats too fast by spreading out the food, placing a salt lick or large stone (one that is too big to swallow) in their feed bucket, or feed smaller meals more often

*If sedating a horse. do not give feed until they are fully awake.

As always, call us if you have questions or concerns about any aspect of your horse’s health or care.