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Should vet charge for this?

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  • #21
    I will admit to laziness here and did not read all the posts above in detail.

    If you agreed to the treatments that were done in the time before you euthanized her, you are responsible for paying for them. Sorry.

    Is not finding a murmur another vet did malpractice? No. Malpractice is just that: MAL practice. Not hearing a murmur is not poor practice. The murmur may not have been there. Cats do have labile murmurs and it is common to not even be able to find them on U/S!! I can hear grade 1 murmurs. Many people can't. Other sounds can "out noise" a murmur, ie lung sounds, back ground sounds, purring, etc. If cat was dehydrated, murmur may not have been there then and only after cat was re-hydrated.

    Accreditation in accupuncture. Any veterinarian can do any proceedure they want. They do not need to be "accreditted" in a particular skill. I am not a surgeon but can do surgery. I am not a radiologist but can do (and intrepret) x rays and ultrasounds. I am not a clinical pathologist but I can intrepret blood work and read blood smears. Etc.

    When to treat vs when to euthanize: This is often a tough one. I treat alot of patients other vets would euthanize. Some of these live. BUT I also discuss with the owners what is involved in the way time, money, prognosis, etc. Some opt to try, some opt not to. In cases where I do offer treatment, neither is right or wrong. Now, there are times that treatment is prob not going to work (too far gone, too many other problems, etc) and those times I do plead guilty to leading the discussion down the euthanasia trail.

    When should "alternative medicine" be recommended: That is an individual professional opinion. Do I personally think recommending acupuncture to treat any CRF, much less in an emergency presentation, appropriate? No. But that is me. I am not a big subscriber to alternative medicine. But I know folks who are, and some are friends. And they claim to get results.

    What are "correct" charges: One area of the country, or town, may be very different than another in charges. Believe it or not, where I work charges less for alot of things than Banfield does!! And we are strictly emergency and critical care (24 hour). Of course there are things we also charge more for ;-)

    I am sorry you lost her and that the events surrounding it were less than pleasant. That makes it even worse.

    Comment

    • Original Poster

      #22
      Thanks for your thoughts Meghan. I think the issue here is that the vet raced directly to suggesting accupuncture and shoving a questionnaire into my hands without discussing in much detail what we needed to address on the weakness, CRF and age-related issues, and what had shown up out of range on the blood work.

      She appeared to be much more interested in indulging in her new income-producing service line than in being focused on what was best for the cat. That's my hindsight perception when not in the midst of emotional meltdown, which as you know is usually 20-20. Most of us would agree to anything to save our pet in that situation.

      She sold me on the idea of extending and improving the cat's life with a course of accupuncture treatments when Lily was actually so ill she didn't last a day. And frankly, I think $1000 for blood panel, UA, and IV drip that barely got anything into her (and how expensive is potassium and a phosphorus binder?) is excessive. Unless my name is Rockefeller and the vet came to the penthouse and spent the night on a cot next to the cat.

      My mom just had a cat examined (found to have oral disease), vaccinated, chipped, some minor testing done, anesthetized, operated on for multiple tooth removal, and sent home with antibiotics for $320. And this is a decent, reputable clinic in a suburban town.

      The lack of accreditation issue is a moral one. Many people I've spoken with take the "you don't charge to practice on the way to being qualified" point of view. While still learning, you don't charge what you would after you are certified to perform that service. Or you don't charge at all.

      I will be asking for a refund of the accupuncture charges, whether I said okay or not. And I think I can make a good case for it.

      Comment


      • #23
        You aren't just paying for the potassium and the phosphate binder. You're paying for the DVM's time, education, and expertise, the fluid pump, the bag of fluids, the line and extension set, the IV catheter, clippers, tape, prep solution, assistant to restrain, electricity so they can see what they're doing....

        Comparing day practice and ER practice prices is like apples and oranges.

        Comment

        • Original Poster

          #24
          Jorge - as Jeff Goldblum said in "Jurassic Park", "Just because you can doesn't mean you should." And I don't give a rip that it was a (barely) after-hours situation.

          This was a 20-year-old cat, very frail, and my question is whether the vet was concentrating on what my pet really needed rather than getting some practice in on her (the vet's) acupuncture accreditation process.

          Just because she has the knowledge, expensive facility, and assistants on hand doesn't mean that she needs to apply all of that firepower in all cases. I am questioning her judgement in promoting an alternative treatment in this case.

          The pet owner's judgement is clouded by fear and upset over a sick pet and so one operates from a position of vulnerability, just as so many people end up expensively overtreated in end-of-life situations because families cling to hope that this or that treatment will work on their dying loved one.

          A form of Darwinism may eventually work this all out, as this vet's reputation for overcharging is widely known - overcharging in this case being defined as being WAY the frack more expensive than any other vet in the metro. She's certainly gotten her last dollar from me, as a very high caliber Blue Pearl facility is only five minutes' more drive away, just over the state line. And they consistently have charged less than this...person. So I'll be takin' my dollars out of town.

          I'm a small business owner myself and have overhead, buildings, employees, kids in college; don't need to see the list of what it takes to run a business. I have to serve my clients well to stay in business, and have for almost 40 years.

          Comment


          • #25
            Originally posted by MizzouMom View Post
            Jorge - as Jeff Goldblum said in "Jurassic Park", "Just because you can doesn't mean you should." And I don't give a rip that it was a (barely) after-hours situation.

            This was a 20-year-old cat, very frail, and my question is whether the vet was concentrating on what my pet really needed rather than getting some practice in on her (the vet's) acupuncture accreditation process.

            Just because she has the knowledge, expensive facility, and assistants on hand doesn't mean that she needs to apply all of that firepower in all cases. I am questioning her judgement in promoting an alternative treatment in this case.

            The pet owner's judgement is clouded by fear and upset over a sick pet and so one operates from a position of vulnerability, just as so many people end up expensively overtreated in end-of-life situations because families cling to hope that this or that treatment will work on their dying loved one.

            A form of Darwinism may eventually work this all out, as this vet's reputation for overcharging is widely known - overcharging in this case being defined as being WAY the frack more expensive than any other vet in the metro. She's certainly gotten her last dollar from me, as a very high caliber Blue Pearl facility is only five minutes' more drive away, just over the state line. And they consistently have charged less than this...person. So I'll be takin' my dollars out of town.

            I'm a small business owner myself and have overhead, buildings, employees, kids in college; don't need to see the list of what it takes to run a business. I have to serve my clients well to stay in business, and have for almost 40 years.
            First of all, sorry for your loss. It is always difficult.

            If the bill was > $1000, then she must have done something other than the acupuncture. I see you said fluids, bloodwork etc. I'd guess the traditional things she did were to address the problem. And yes, after hours treatment is expensive these days.

            As far as acupuncture, there is actually no "accreditation" available. There is one school that give you a certificate of completetion and two that offer "certification" programs. There is an organization that does certify veterinary acupuncture, but it is not one of the AVMA specialties, it is independent. Some states require you to have completed a course. One may have completed the course and still not be "accredited", it really doesn't mean that much. Now if she has just completed her first module, I'd say she should probably not charge. If she had finished all of the course, just had not taken her tests or finished her case reports, then she probably should be charging for her services.

            As far as adding acu to a critical case? In some cases you can help the animal if you use it along side your emergency medicine. I don't see anywhere how she neglected the traditional medicine for you cat. As mentioned above, the murmur may not have been presnt on initial exam. And as far as asking about if she was strong enough, there are no guarantees.... Perhaps she believed she was (as evidenced by the head nod). It sounds like she is enthusiastic about her new Acu skills and really thought it would help your cat.

            Again, sorry for your loss. You can choose to never use this clinic again, but I don't see that she did anything that violates ethical or practice standards.
            Turn off the computer and go ride!

            Comment


            • #26
              Originally posted by foggybok View Post
              First of all, sorry for your loss. It is always difficult.

              If the bill was > $1000, then she must have done something other than the acupuncture. I see you said fluids, bloodwork etc. I'd guess the traditional things she did were to address the problem. And yes, after hours treatment is expensive these days.

              As far as acupuncture, there is actually no "accreditation" available. There is one school that give you a certificate of completetion and two that offer "certification" programs. There is an organization that does certify veterinary acupuncture, but it is not one of the AVMA specialties, it is independent. Some states require you to have completed a course. One may have completed the course and still not be "accredited", it really doesn't mean that much. Now if she has just completed her first module, I'd say she should probably not charge. If she had finished all of the course, just had not taken her tests or finished her case reports, then she probably should be charging for her services.

              As far as adding acu to a critical case? In some cases you can help the animal if you use it along side your emergency medicine. I don't see anywhere how she neglected the traditional medicine for you cat. As mentioned above, the murmur may not have been presnt on initial exam. And as far as asking about if she was strong enough, there are no guarantees.... Perhaps she believed she was (as evidenced by the head nod). It sounds like she is enthusiastic about her new Acu skills and really thought it would help your cat.

              Again, sorry for your loss. You can choose to never use this clinic again, but I don't see that she did anything that violates ethical or practice standards.
              but it seems that a decent professional would have opted to not even do fluids.

              Not just ot charging for the practice session, but also avoiding care when the animal was that bad off.
              I think the Hippocratic oath is the same for people and animal doctors: Do no harm.
              Originally posted by BigMama1
              Facts don't have versions. If they do, they are opinions
              GNU Terry Prachett

              Comment


              • #27
                Sorry about this. It is really hard not to feel screwed over in a situation like this. My little sister sent her cat (possibly hit by a car) in to the emergency vet. They called to give my sister a status update after a couple hours, then called back shortly thereafter to recommend a blood transfusion. She told them that she couldn't afford that. They called back 5 minutes later to tell her the cat died, at which point my sister (who doesn't mince words) called them "fucking profiteers."

                Most of us are pretty well convinced that the cat expired before they recommended the transfusion.
                It's a uterus, not a clown car. - Sayyedati

                Comment

                • Original Poster

                  #28
                  Thanks Foggy - the vet, and I quote, said that she was "working toward her accreditation" in animal acupuncture which she would finish up this fall, and that she had treated several pets who were all still doing well lo, these six months later, though one had died that she believed must have had a brain tumor. I sh*t you not.

                  In some circles this is called charging your clients to practice on them before you are certified.

                  And there was more to the sales pitch, which took far longer than the discussion about the various out-of-range values on bloodwork and what we might do for that.

                  The nod I take as a slightly sneaky way of not actually saying out loud, "yes, she's strong enough for treatment". Which, verbally committed, would possibly fall into the unethical behavior area, or at least dubious judgement.

                  And Slew, your sister is a woman after my own heart. I'm going to write her pithy phrase on a 3x5 note card and put it with my furious epithets collection box because I'm sure I'll probably have need of it someday.

                  Comment


                  • #29
                    Originally posted by Slewdledo View Post
                    Sorry about this. It is really hard not to feel screwed over in a situation like this. My little sister sent her cat (possibly hit by a car) in to the emergency vet. They called to give my sister a status update after a couple hours, then called back shortly thereafter to recommend a blood transfusion. She told them that she couldn't afford that. They called back 5 minutes later to tell her the cat died, at which point my sister (who doesn't mince words) called them "fucking profiteers."

                    Most of us are pretty well convinced that the cat expired before they recommended the transfusion.
                    Wow, so you find it impossible to believe that a cat in critical condition and bad off enough to need transfusion could rapidly go downhill and die? A transfusion often does not fix the underlying problem. The cat could have been bleeding faster than they thought, or had a coagulopathy and been unable to stop bleeding, or a clot could have dislodged and started a torrent of internal bleeding that had stopped (or it could have had a severe hemolytic anemia, also not a good thing). BTW, the vets I know don't transfuse unless things are going so badly the animal is experiencing or about to experience problems from lack of oxygen carrying capacity, so it's not like the animal is having a good day to begin with. In a trauma situation, you have to make life-and-death decisions quickly, and the outcome is often uncertain. When the cat was bleeding and in trouble, should they have let it bleed out instead of trying to save it?

                    SquishTheBunny, dialysis is expensive and available at only a small number of places in the US. It is also unnecessary for many cases of renal insufficiency if the animal is still making urine and able to be diuresed.

                    Alagirl, everyone has a different threshold of what risks they are willing to take, and trying to prognosticate an animal's chances is a big grey zone - they often don't read the book, and critically ill patients can go from stable to crashing and dying in a short period of time. It's not clear to me that this cat was beyond hope the minute she walked in the vet's office.

                    MizzouMom, as for the after-hours part, you ARE paying for the fact that the clinic is open at all hours regardless of caseload, stocked with expensive equipment and paying veterinarians and veterinary technicians who often get a salary differential for working at night and must be paid even on nights when only 3 patients walk in the door. It's the same in human ER's, if more complicated in terms of billing - everything is more expensive because you are paying for expertise and convenience. If you don't want to pay for an emergency clinic, you can wait until the next day to see your regular veterinarian, who has lower and more predictable expenses.

                    As for the estimate, it is common for the first day to be much more expensive than subsequent days, since the initial exam and work-up of the case, procedures, getting cath/fluids/etc. set up, and so on often take the most personal attention and resources, with following days requiring less.

                    All that aside, I'm so sorry for your loss. Losing a beloved cat is never easy.
                    The plural of anecdote is not data.
                    Eventing Yahoo In Training

                    Comment

                    • Original Poster

                      #30
                      Gato, thanks for your condolences.

                      Yeah, this clinic is only open for a whopping 2 hours past regular time - the 24-hour Blue Pearl facility actually has charged less for an identical urinary tract crisis as the "sorta expanded hours place" (daughter has been two through urinary blockages with her boy kitty, went both places - paid $200 more for a dinnertime visit than the midnight one at BP).

                      And yes, the higher initial charges include bloodwork and exam. My breaking point was the $145 charge for "consultation and treatment" to initiate acupuncture regimen on what turned out to be a cat with less than a day to live, though treatment was pitched as an ongoing care designed to improve quality of life. Consultation consisted of vet pitching the treatment, me filling out a form about my cat's earth/fire/water/air tendencies, and vet saying she could squeeze in a treatment before she left town.

                      Those deserving, underpaid, underappreciated staffers didn't noticed Lily's severely swollen paw the next morning from a too-tight IV wrap, called her a "he" - calicos are universally female. Made me wonder just how closely anybody was paying attention as they chit-chatted over a dental.

                      Hell hath no fury like a woman who has lost a long-time family member.

                      Comment


                      • #31
                        Originally posted by MizzouMom View Post
                        Thanks all for your thoughts. This vet is slick - when asked whether Lily was strong enough for treatment, she nodded once but didn't actually say "yes". I would be hard pressed to make a legal issue, unless our state requires accreditation prior to accupuncture treatment.

                        Lily wasn't actually in renal failure, I'm proud to say that the three years of fluids support at home kept her kidneys reasonably functional and she wasn't even anemic - the lab findings were out of range on potassium, phosphorus, and with the hyperthyroid bonus, and only mild to moderate elevation of kidney values. All my fault for not catching it sooner, but as you mention with yours, Magnolia, this cat would have HATED being medicated daily. And she had pottered around doing quite well until the last week.

                        Her extreme weakness was the worst presenting symptom, which was glossed over as the vet rushed to accupuncture discussion and had me fill out a form about her water/fire/air etc. traits. No lengthy consult involved for the $90 "consult" fee.

                        So I'm done bitching, I think; it's draining. My daughter decided my extreme sadness was too much and gave me a healthy kitten two days ago, who is on my lap. Not something I would have run out and done for myself, but he is turning out to be the best medicine.
                        Your daughter is an angel and very wise. My recommendation is to write up the complaint and submit it where it needs to go, write a letter to the editor and warn the vet clinics in the area with a letter (pour your heart out, but make it clinical). Let the passion for the injustice not concentrate on the criminal con job who made the passing so horrible.There are so many stupid flagrant speculators out there right now, the world is full of them. Never worry, time, the economy and word of mouth will take care of this nut. Sad that others may suffer but you will do yourself and your family more harm by letting it poison you. Enjoy your sweet, lively cute little kitten, fully enjoy. Take a trip away from the area if necessary, go to the sea, read a profound work, don't let the crime take your essential goodness away, don't let her into your soul. I know of what I speak. I am so sorry that this happened to you and your beloved old buddy. I am sure your kitty would not want you to lose you.
                        "We, too, will be remembered not for victories or defeats in battle or in politics, but for our contribution to the human spirit." JFK

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