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Should vet charge for this?

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  • Should vet charge for this?

    Our beloved elderly cat died last week of complications of CRF. Most clinics close at 5, and it was 6 p.m. when we arrived at the only after-hours clinic in town.

    I asked the vet, owner of the clinic, specifically if our girl's heart and lungs sounded strong enough for treatment for her various issues, and she nodded but did not answer aloud. And then she pitched a course of accupuncture for our cat, which she said she was studying to become accredited in. She cited several of her clients who had benefited from accupuncture, and suggested that it would help our old girl's arthritis and appetite.

    Proposed charges for a four-day nonsurgical hospitalization with conservative treatment of fluids, meds, blood panel, UA accupuncture was over $1800. My adult children grew up with this cat that I loved dearly, so I agreed.

    The cat went into organ failure by the next morning and we let her go that afternoon. The bill for less than 24 hours of nonsurgical care was over $1000, including $145 for accupuncture consult and a single treatment.

    My question is for opinions on the ethics of charging for treatment in which the vet is not accredited, i.e. the accupuncture. My angry, hurting self wonders if the vet was lying about our cat's condition, as I was told the next day by another vet on staff that she had a heart murmur, and she expired from the sedation shot alone. I also uncharitably wonder if the vet needed to get in a few more accupuncture treatments to get her accreditation.

    This clinic is famous for overcharging, but they are the only after-hours place in town. Maybe I am responsible for agreeing to treatment while in a distraught emotional state, but I feel like the victim of highway robbery. I am going to request a refund of the accupuncture charges, which may be like spitting in the wind. The state veterinary board says I can file a formal complaint, but won't say if it's unethical to charge while performing procedures without accreditation.

    Does anyone have any ideas?

  • #2
    I will say that acupuncture laws still vary greatly from state to state, but in NC it is not required to be accredated to do it. Nor is it even required for you to be a DVM..... although the AVMA considers it a permanent change they have no legal bearing over what is done.

    I will also say that $145 is more than the accredated vet here charges for her initial consult and treatment. The onstaff vet who is still in the process of getting her accredation is more like $35, then will go up to about $60-80 once she's done. HOWEVER whle I'm talking daytime prices, I will also say that for many admitted patients, we have considered it just part of thier hospital stay(although informing the owners before hand) and do not charge for it. The vet considers it part of her learning process to see if the results correspond to what she has been taught.

    Only the other vets/techs will get this but our new clinic has become "Don't let it die without steriods.... and a F'N needle!!"

    Katherine
    VetTech
    You can't fix stupid.... but you can breed it!

    Comment

    • Original Poster

      #3
      Thanks for your candid comments Horsegal. I know that I was bent over, basically, by this woman. She has this cherubic face and sells you a bill of goods, and you want to believe.

      I am going to request a refund of the charges and will Never. Ever. Go there again. I'll have to drive to get to an ER, but so be it.

      Comment


      • #4
        I've worked both sides of the coin so to speak. I started in daytime, went to ER, and have moved back to daytime, mostly because we wanted to start a family, and partly because my liver needed to recover.

        ER costs where I worked were higher for the exams, and the unnecessary type services, which helped to discourage people from coming in on a Sunday afternoon for an ear infection their pup had for 2 weeks. However, our prices were within 10% of most of the other clinics around for the needed stuff, like in house bloodwork, IV catheters, fluids and radiographs. They desigined it this way to help prevent people with non emergencies from coming in, but the ones who needed diganostics now from trying to save money by waiting.

        So my persperctive may be a little skewed from working in one of the really good clinics but I still feel paying for the acupuncture is out of line. Esp since your kitty did not make it.

        However..... it is entirely possible for a heart murmur to develop in a very sick kitty in a few hours, just from the supportive care neede for her kidneys.

        Katherine
        Vet Tech
        You can't fix stupid.... but you can breed it!

        Comment


        • #5
          FWIW, I treated pets with chiropractic adjustments before I was certified, but never charged until I was certified. I was just grateful for the practice.

          Comment


          • #6
            Im sorry, but absolutley NOT. First off, I would be pissed that "accupuncture" was a treatment for your pet. Sure, its a type of homeopathy but it will not cure a sick animal dying of renal failure. A "free" service or a service that you particularly inquired about - fine...but I would not be pleased to see that on my bill for my pet that is no longer alive.

            Fixing "appetite and athritis" is absolute Bull in my opinion. Eating and happy joits are not going to fix kidneys - dialysis will. And saying that...a fe dys f IV fluids isnt "real" dialysis either.

            accupunctue can work great in conjuntion with regular veterinary medicine with particular cases (epilepsy especially), but for your cat that was THAT critical, I would rather the $ go into a criticalist managing dialyss.

            Im sorry for your loss.

            Comment

            • Original Poster

              #7
              Marshfield, that goes with what my gut says - despite the eye rolling from people who said "What, accupuncture for a CAT?!", the thing that got me was a health professional saying that it was inappropriate to charge a client to practice on them, which is basically what pre-accreditation treatment is.

              And Horsegal, I know you're right about the heart murmur, but I'd be willing to bet it was there the previous night from the way the vet responded to my question about her condition.

              Comment

              • Original Poster

                #8
                And thank you SquishTheBunny - this is our second loss in 6 weeks and I'm emotionally shot. I'm in that anger stage of grief, not that my anger isn't justified. 20 is a pretty good age for a cat, but somehow it's never enough. Her poor sister is now in my laser sights - we're going for blood panel tomorrow as a preemptive strike (to a different vet!). She looks good but I'm on it just in case!

                Comment


                • #9
                  I'd be thinking along the lines of malpractice. " I was told the next day by another vet on staff that she had a heart murmur." The examining vet didn't tell you that immediately during the initial consult??? Was she too busy sticking needles into the poor animal to get out a STETHOSCOPE?? That's just gross negligence, IMHO.

                  Make sure that the heart murmur is noted on the paperwork (BEFORE you pay anything), and/or get the other vet to add that to your kitty's chart. Then I'd think for a while about whether or not you're obligated to pay the bill at all. They withheld significant medical information from you without advising you about the dangers of the sedation because of the heart murmur. If you'd known, you may have opted to put the kitty down right away.

                  Even if you don't pursue this, I would no way in hell pay that acupunture charge. I might file a complaint with the state licensing board about unethical practices.



                  I realize that I'm generalizing here, but as is often the case when I generalize, I don't care. ~ Dave Barry

                  Comment


                  • #10
                    A heart murmur certainly can develop in a short time, FWIW, especially in a cat with renal disease. The fluids can make the murmur worse. It's hard to prove if the cat had or did not have the murmur on admission -- it's very possible it didn't.

                    I personally think that acupuncture is not life-saving treatment and if a kitty presents to me on ER in renal failure, you can bet that trying to support it through that is my #1 priority. It's possible the severity of your cat's condition wasn't fully evident on presentation (to you, the vet, or anyone) and no one expected her to decompensate that quickly. Either way, I think it's fair to ask for a refund for the acupuncture portion.

                    Comment

                    • Original Poster

                      #11
                      Thanks for weighing in, Pancakes. I'm sure you're right on the mark about the murmur, and the treatment choice that was made.

                      This is one of those situations where the woman bought a long-time practice in a nice older downtown building, then built a $1.3 mil building on the edge of our old blue collar town, dressed all her employees in scrubs, and the testing testing testing charges got higher.

                      Last summer I took our feluk kitten there for an intestinal emergency (of course just after regular closing, because that's when all my animals present with issues), and before I was allowed to leave and get a drink while awaiting labwork, was required to make a $250 deposit to be sure I'd come back for the cat. We've been in business in this town for 24 years, former Chamber president, etc., but I guess I can't expect the bank of women behind the custom-built reception foyer to know that.

                      Man, I sound bitter. It's so unattractive, but there you have it. Guin, if I could withhold payment I would, but these people require full payment before you get out the door.

                      There is some satisfaction in noting that there's been a steady decline in the number of vehicles in the parking lot for some time. Word of mouth still works.

                      Comment


                      • #12
                        It is standard practice in every ER in which I have ever worked to require a deposit when a patient is hospitalized.

                        And funnily enough, it's often the "pillars of the community" who try to stiff you.

                        Comment

                        • Original Poster

                          #13
                          Anne, point taken. I know that I'm good for the bill and will do about anything for my pets, but these people aren't mind readers.

                          It's also true, however, that I have had pets there before with exorbitant bills that I paid on the spot, am well known to the clinic owner, and was on that particular occasion schmoozing mightily in the lobby with the director of the local no-kill (who work exclusively with this clinic because they rent the old clinic space) who can vouch for me, since I'm their biggest donor. Yes, we "pillars of the community" can get our dander up when we're treated like deadbeats, though we don't really have any reason to expect better.

                          And the kitten was not being hospitalized, just worked up, and I was going to get a drink, not leave the country.

                          I've spent a long time building up my cred in this community and keeping a business going successfully in these crappy times, and so have an ego to match. And I've also had the pleasure of being financially screwed by people who should know better. A mentor in our same professional was even screwed financially by the then-mayor of Kansas City, so I'm familiar with the issue.

                          I wasn't all up in arms at the time, but after recent events they are high on my sh*t list.

                          Comment


                          • #14
                            Having also been on both sides working in a higher end small animal clinic as well has requiring emergency services from after hours and specialty clinics for my own pets, I think that that the fact acupuncture was even SUGGESTED in an emergent situation was ridiculous.

                            I am all for blending traditional and non traditional medicine in some situations--but I cannot wrap my head around acupuncture as a treatment for acute illness.

                            I can't say that I'd necessarily consider it malpractice IF all of the other generally accepted protocols were followed. But if they weren't followed because the fruit loop was too busy practicing her acupuncture on your cat? I probably wouldn't stop with a strongly worded letter.
                            A good horseman doesn't have to tell anyone...the horse already knows.

                            Might be a reason, never an excuse...

                            Comment

                            • Original Poster

                              #15
                              BuddyRoo, I think I love you.

                              Comment


                              • #16
                                I will say, vets can disagree on renal failure and how to treat.

                                Same office... Vet 1.Looks at blood panel. Kitty needs fluids, we can hospitalize and likely get her stabilized. It will be $xxxx. I thought about it and was like, no. This cat will hate that. So I made an appointment to euthanize the next day.

                                Vet 2 (same office), looks at blood panel results. Tells me I am making the right decision, more at work than renal failure. I'm not sure if he was just being nice.

                                Maybe your vet was super hopeful.

                                On the $165 for accupuncture, our vet is also a homeopath and they charge a significant amount for the initial exam for going that route. The initial exam is like an hour long consult with you and the vet and discusses all aspects of your pets lifestyle. I want to say they used to charge $90 and it would map out the treatment. But I don't think they charge that much for accupuncture or chiro treatments, nor do they require the consult. They are certified.

                                I'd call and get that $165 refunded. But I'd give her the benefit of the doubt that she was hopeful the cat would stabilize and benefit from the accupuncture and was not merely trying to pad your bill.

                                Comment


                                • #17
                                  Originally posted by MizzouMom View Post
                                  Marshfield, that goes with what my gut says - despite the eye rolling from people who said "What, accupuncture for a CAT?!", the thing that got me was a health professional saying that it was inappropriate to charge a client to practice on them, which is basically what pre-accreditation treatment is.

                                  And Horsegal, I know you're right about the heart murmur, but I'd be willing to bet it was there the previous night from the way the vet responded to my question about her condition.

                                  yep.
                                  I think I'd be livid, because cherubic faced 'doc' coned you into providing treatment when you probably would have either taken kitty back home or opted to put her down on the spot.
                                  1800 bucks for a 4 day stay, vs a 1k overnighter?

                                  I am certain that I would not take this laying down.

                                  Comment


                                  • #18
                                    Mizzou, I felt compelled to add this tidbit...

                                    I had a HORRID experience with the local emergency clinic.

                                    When I worked in veterinary medicine (been out of it for over 10 years now), we saw our own after hours emergencies. It was kind of bizarre to me when I moved to MI that I couldn't see my regular veterinarian after hours but that's how it is with all of the clinics here.

                                    Anyway, my dog woke me up at about 4am having small focal seizures. I was keeping track of the timing and his vitals. Then he started having petite mal seizures as well. by 6am, he was having focal seizures every 2 minutes lasting a few seconds with petite mal and grand mal seizures mixed in. I called the emergency clinic and let them know I was on my way. I had video of the seizures, I had kept track of each one on paper.

                                    Got there. The doctor charged me $180 bucks, didn't even do an exam, wouldn't start the blood work, and didn't look at my video or notes. The dog was still have focal seizures and the guy told me to just wait til my clinic opened. SERIOUSLY?

                                    Long and short, I did get in to my vet, they couldn't stop the clustering and we ended up at the doggy neurologist where he had to be put in essentially an induced coma for 24 hours to knock out the seizure activity.

                                    All I wanted that damned vet to do was get started on the blood work, give the poor chap some valium to calm the activity, etc--or whatever else NEEDED to be done.

                                    Believe you me, I wrote up a complaint. And I told my vet (whose after hours recording recommended the clinic.) She no longer refers anyone there. I am a competent pet owner and am willing to pay through the nose for a good veterinarian. I spent nearly 7k over the course of 2 days on my dog. Up front. In cash. My veterinarian and I have a good relationship. I have even assisted in surgery when my dog had an obstruction a few years later. So it's not like I'm some wannabe fruitloop pet owner.

                                    I have never been so offended and irate about a veterinary situation before or since.

                                    So perhaps my inner rage is affecting the tone of my thoughts on your situation.
                                    A good horseman doesn't have to tell anyone...the horse already knows.

                                    Might be a reason, never an excuse...

                                    Comment

                                    • Original Poster

                                      #19
                                      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.

                                      Comment


                                      • #20
                                        Originally posted by magnolia73 View Post
                                        I will say, vets can disagree on renal failure and how to treat.

                                        Same office... Vet 1.Looks at blood panel. Kitty needs fluids, we can hospitalize and likely get her stabilized. It will be $xxxx. I thought about it and was like, no. This cat will hate that. So I made an appointment to euthanize the next day.

                                        Vet 2 (same office), looks at blood panel results. Tells me I am making the right decision, more at work than renal failure. I'm not sure if he was just being nice.

                                        Maybe your vet was super hopeful.

                                        On the $165 for accupuncture, our vet is also a homeopath and they charge a significant amount for the initial exam for going that route. The initial exam is like an hour long consult with you and the vet and discusses all aspects of your pets lifestyle. I want to say they used to charge $90 and it would map out the treatment. But I don't think they charge that much for accupuncture or chiro treatments, nor do they require the consult. They are certified.

                                        I'd call and get that $165 refunded. But I'd give her the benefit of the doubt that she was hopeful the cat would stabilize and benefit from the accupuncture and was not merely trying to pad your bill.
                                        Magnolia and I go to the same vet clinic - my dog is currently undergoing acupuncture treatment - each treatment is $68. From an accredited acupunturist, I might add.

                                        Comment

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