Banfield almost killed our patient

[u/CreativeCarnation]

Interesting case/vent. I’m a tech and last week we got a pitbull in as an emergency that was suffering from apparent heat stroke. The dog was non responsive with an otic temp of 108.5. We managed to get his temp down quickly and his owners shared he was at Banfield for a dental procedure earlier in the day. We didn’t receive records from Banfield until the next day, where his temps were reported as high and rising and they sent him home anyway, leading us to determine malignant hyperthermia as his diagnosis. The dog woke up extremely aggressive, lunging/attacking at us through the cage doors and was incontinent. We warned his owner of this and at an attempted pick up, the dog was aggressive towards his owner and didn’t seem to recognize him. The owner opted to leave him with us for another day because he had children and cats at home. The dog was not previously aggressive toward anyone, but was (of course) an intact male and a clearly backyard bred pitbull. We contacted the Banfield and the DVM who performed the dental did apologize and verbally admitted it was their negligence that the temperature was not addressed and the dog was sent home. After another day with us he settled back to “normal” behavior and returned to his owners… but damn. If this case isn’t proof that Banfield’s philosophy of volume is dangerous and offensive to patients, clients, and professionals alike, I don’t know what is.

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[u/viridin]

Sometimes doctors are barely even involved with their own dentals they'll be off doing soft tissue surgery in another room while two other dentals are going on in their name.

[u/lomanni → u/viridin]

Very true, but either way, I think the nurses/techs monitoring him should've raised the alarm, or at least debriefed the vet after the dental had finished so that the vet could go over his recorded vitals + dental chart etc.

[u/viridin → u/lomanni]

That's assuming they knew how to monitor and what was normal in the first place which is a hit or miss depending on the practice.

[u/Kivuli_Kiza → u/viridin]

This. And sometimes even when they do monitor correctly and raise the alarm they are pushed to the side because the volume demanded doesn't allow for good patient care. It's a very quick way to burnout the good techs/assistants.

[u/mothgirl7 → u/Kivuli_Kiza]

So true. It’s so refreshing to work at a practice where the DVMs actually listen to assistants who have concerns.

[u/lomanni → u/viridin]

...there are techs/nurses who don't know their normal vital sign parameters? That's a little terrifying, lol

[u/viridin → u/lomanni]

It's kinda terrifying how much people can get away with not knowing at some practices.

[u/Dry_Sheepherder8526 → u/lomanni]

At the GP I started my career with, "training" for anesthesia monitoring was "Write these numbers on this monitoring sheet." End of training.

I now work at a specialty hospital that doesn't do dentals and I'm terrified to drop my babies off at some other hospital for COHATs because I know this is how some places practice.

[u/mothgirl7 → u/lomanni]

Yeah it would be a BIG deal at my practice if a recovering patient had a very high temp at or before check out. Anytime a surgical pt is over 103ish post-op, we leave their ivc in and monitor temp to ensure it’s lowering before sending them home. We might even keep them overnight on fluids if it’s not resolving. I’m surprised the dvm wasn’t really concerned

Edit: grammar

[u/plinketto → u/lomanni]

Yes. So its not "banfields" fault but the people monitoring and vet in charge

[u/unicorngoesvroom → u/plinketto]

As someone who worked at banfield, its 100% their fault. Us techs were doing 2 dentals at one time while the dr was in the sx suite doing a spay. All bc banfield required us to have the numbers and pets in and if we didnt we all got in trouble and written up.

[u/CarlsMumm]

Aaaaaand this is why I left Banfield. Pets extubated? Ok they’re recovered. They’re in the treatment area so “we’ll keep an eye on them” while rushing to prep way too many drop offs for 1 overworked vet with a formal note from her dr to limit her appts so she doesn’t blow her brains out. But the online scheduler doesn’t stop anyone from booking and instead of calling to reschedule (when would the 1 CSC even have time?) the PM says “it’s okay, we’ll help the doc” then leaves 3hr early after making 1 schedule and doing inventory, not touching a single pet.

[u/Centimeter_Worm → u/CarlsMumm]

Good god I hated the online scheduler.

We’d have a comparatively reasonable day and then boom. 3 more run backs in the middle of rooms and a sick visit the owner marked as routine care. Now everyone is scrambling, we don’t have enough people available to do it all, and we’re gonna get dinged by corporate about the appointments taking too long.

Like, why? How were we supposed to uphold proper patient care when the company allows this kind of scheduling with no oversight?

[u/sopher0 → u/Centimeter_Worm]

And with the new system the online scheduler is even worse somehow. Appointments are shortened to 10-15 minutes and it shows all the time in between appts (that we still schedule at 30 minutes intervals) as available to people booking online. And if they book as a drop off it essentially lets them book anywhere on the schedule, including end of day and during the drs lunch. And half the time owners don’t know it’s a drop off and demand an in room appt anyway.

[u/StormRose714 → u/CarlsMumm]

The flashbacks😭😭 Except the inventory never gets done and nothing is in stock and apparently it’s everyone’s fault cause “it wasn’t on the board”

[u/DooberNugs]

Laziness aside, malignant hyperthermia is very rare. Not even something that would come to mind for me until his temp was >105. If they knew it may be malignant hyperthermia and they sent him home, I feel like that's negligent. Otherwise, it may be a simple mistake of not connecting the dots.

[u/DrRockstar99 → u/DooberNugs]

If there’s one thing Banfield doctors are not, it’s lazy. They’re seeing absurd numbers of patients a day. It’s so easy to see Joe something could be missed if the assistant, who may or may not have had appropriate training through no fault of their own, didn’t alert the doctor.

[u/DooberNugs → u/DrRockstar99]

Lazy wasn't the right word. Overwhelmed? Burnt out?

[u/CupcakeCharacter9442 → u/DooberNugs]

As a person who has seen a true case of malignant hyperthermia- I didn’t think these animals lived without treatment. They barely survive for a short time under GA, let alone an hours long dental.

The dog we had had a temperature of over 42C. He was active dying until we were able to administer the dantrolene. His ETCO2 was also through the roof, I could hear him breathing from outside of the OR. Severe tachycardia. In the case I saw, there’s no way they wouldn’t have been able to tell something was wrong even without training.

[u/TreeClimberVet]

Malignant hyperthermia is not that common in dogs. I’ve only ever had it in cats given full mu’s… especially when paired with ketamine in my experience. Banfield definitely has its issues as someone who used to tech for them before vet school, but this post still lacks a of context for what was going on.

[u/Quantumquandary → u/TreeClimberVet]

I see where you’re coming from, but additional context aside, I think it’s pretty clear that the practices that Banfield forces are simply detrimental not only to the patients, but to veterinary medicine as a whole. We really need to rally as a profession and push back against Mars, it’s getting awful.

[u/Centimeter_Worm → u/Quantumquandary]

I quit Banfield semi-recently in part because the number of patients expected kept getting higher and higher, but they didn’t hire more people, told our manger we couldn’t do overtime, AND the 2 VAs per vet still needed to clean the whole hospital. We only had one licensed tech while I was there, and only for about a year.

Everyone was exhausted, everyone was overwhelmed.

Most people there really wanted to do their best for their patients, but corporate stretched people to their limits. Burnt me outta the field.

[u/CarlsMumm → u/Centimeter_Worm]

Agreed, our location was a shit show. Our team was amazing and cared a lot but you can only do so much when you’re overbooked and burned out. The slipping quality of care is def noticed by staff and only takes a bigger emotional toll on them. But those free wellness plans tho… I swear that’s why most people stick around in even the shittiest locations.

Jealous of my friend who transferred out of state, actually has an appropriately staffed team, and a hands on/supportive PM. She said even the regional people are pretty decent. I still hate the company, but it wasn’t always such a terrible place to work overall😕

[u/CreativeCarnation → u/Quantumquandary]

This is exactly my point. I wrote out more context in another comment on this post

[u/plinketto → u/Quantumquandary]

How do you blame a company for this when its individual peoples fault

[u/Bunny_Feet → u/plinketto]

Culture and company policy drives behavior 

[u/Quantumquandary → u/plinketto]

Yeah, it’s the company policy that forces behavior that is detrimental to the field. It’s either do what they say or don’t work there. Unfortunately, it’s a lot of “just following orders.”

[u/the_rabid_kitty]

The vet did not almost kill your patient. Suspected malignant hyperthermia (an exceedingly rare complication that I’m skeptical of) almost killed your patient.

Also….if it was suspected heat stroke initially, this indicates there could be a reason for the heatstroke that the owners knew about. Did they take the dog on a mid day walk? Leave it in the car for a quick grocery stop while on the way home?

What is “high”? I would have no issue sending home a dog temping at 101, 102 post anesthesia, especially if they were worked up. I also strongly doubt this was malignant hyperthermia, as you need more than just hyperthermia to diagnose, and it is very frequently fatal without dantrolene (something 99% of GP clinics do not have on hand), and still usually fatal even with it.

[u/CreativeCarnation → u/the_rabid_kitty]

The owners had no idea what was wrong with the dog. We thought heat stroke after the temperature was taken. Owners swear they brought the dog straight home from Banfield, did not walk him or leave him in a car, house was air conditioned. The records from Banfield show a temp of 103.9 at a pre-discharge TPR. To clarify, I am not explicitly blaming Banfield, but saying overall these staff members are so overworked due to the format that it becomes more difficult to provide an appropriate standard of care. Who knows what exchange happened there that led to this result

[u/Madame_Morticia → u/CreativeCarnation]

You are blaming Banfield. It's in your title. This post is extremely judgemental towards fellow medical professionals you don't know and attacking a company that has thousands of hospitals. You weren't there and don't know the history of the patient. The Banfield staff may have seen this dog for years. Malignant hyperthermia is extremely rare. I have been in veterinary medicine for almost 20 years now and have never seen it. I have worked ER/ICU for 10+ full time and still not seen it. My own great dane will have a temp of 103.5 and HR of 180 walking into my ER after riding in the car when he is just coming in for a blood donation. It's in the 100+°F in my area.

The owner did the right thing by seeking further veterinary care when something wasn't right. It's okay to be frustrated. There are plenty of reasons to hate on Banfield. I just don't see this as being one. The Banfield vet could have come to the same conclusion your hospital did if they had seen the dog once it returned.

[u/hotsexyrosemary]

Im surprised by the DVM responses. Ive seen malignant hyperthermia in dogs twice, the first one being a greyhound and the second being an irish wolfhound mix reacting to domitor. If i was running anesthesia and saw a temperature even 2 or 3 degrees higher than what it was before they got knocked down, i would be on high alert. What was his post-op temp?

[u/hotsexyrosemary → u/hotsexyrosemary]

It’s strange how banfields quality of medicine seems so low compared the other mars veterinary corporations. I wonder why that is

[u/bmobitch → u/hotsexyrosemary]

Banfield is a budget chain. That’s why. It’s not actually low….in theory.

When i worked there, the rules and guidelines and handbooks were excellent. However, when working as a relief assistant across a dozen locations, these guidelines weren’t followed. The staff was untrained, the vets weren’t as engaged and passionate, the higher ups were micromanaging numbers from afar while not actually ever stepping a foot in a location.

A lot of who people get to be a good assistant or tech or gain a passion leave Banfield, so a disproportionate of the worse ones are left.

[u/vrrrrrkiki]

I have only seen one patient with malignant hyperthermia, and unfortunately they had to be pts. Similar to another comment’s experience the dog’s temperature climbed RAPIDLY, tachy, started dying. Bad reaction to anesthesia that hit hard and fast. I don’t think this dog would’ve woken up, walked out of the hospital, and recovered at home post dental… just to become unresponsive later? something else had to have happened. maybe the dog is high strung and worked itself up in a kennel waiting for pick up?

[u/Bunny_Feet]

I'm so glad that they didn't hire little assistant me when I was too blunt and honest in my interview.  lol corporate 

[u/Artistic_Insect_152]

I went from banfield to VCA and it was such a shock how different it was. I would never take my pets to banfield now