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Monday, November 29, 2010

Where Does Obligation End? Part 1

Recently we had a client visit one of our clinics (we're a multi-location practice) because she believed her dog had eaten some rat poison.  The doctor worked up a treatment plan and it was presented to the owner.  She said that she could not pay for the services.  She was offered Care Credit (a medical credit card here in the US), but said she wouldn't qualify.  She didn't have any other credit cards, and said that her check would bounce.  Basically she was offered every payment option we have (we don't do in-house billing and payment plans), but couldn't do any of them.  So treatment was not performed and she was referred to a local emergency clinic in hopes that they might be able to work out payment with her.  Her visit there ended up the same way, with her being unable to make any payment and the emergency clinic declining to treat without being paid.

Almost two weeks later I saw her dog for acute vomiting.  The dog was acting fine with no signs of having had any bleeding problems (the main complication of most rat poisons).  She was on a health care plan with us that allowed some blood testing at no additional cost (it doesn't cover treatments, just basic preventative care), so we ran these and everything came back normal.  Since the owner couldn't afford any other diagnostics I put the dog on some antinausea drugs and sent her home for observation.  What else could we do?

During all of this mess the client has been belligerent and confrontational.  She has accused us and the emergency clinic of "neglect and abuse" for "refusing to treat" her dog.  She has made statements that we are "killing her dog", that we "don't care about animals", and everyone is "just about the g**d*** money."  She is threatening legal action if her dog dies (it's been close to four weeks now, so the chances of that happening are slim) and has called us repeatedly with complaints and abusive language.  In her opinion we should have treated her dog regardless of her financial situation.

Personally I'm not worried in the least about this client, as I know that we and the emergency clinic offered every appropriate action and treatment.  We have documented all conversations and declined services, so she has absolutely no legal ground for a suit.  However, it does bring up an interesting question that I'm putting to a poll.  Does a veterinarian (or by extension, any doctor) have an obligation to treat a patient regardless of the ability to pay?  Every veterinarian sees pets who don't get needed treatment because the owner can't afford it.  In many cases these pets end up suffering or have chronic problems, despite the fact that have the ability to treat them.  According to this owner's comments, we should be treating them anyway.

So let's see what the poll says and then we'll revisit this topic in a little over a month.