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Thursday, December 6, 2012

No Money, No Options, No Luck

Earlier in the week I mentioned a specific case and someone in the comments asked for details.  I was planning on posting about it anyway because it illustrates a very difficult situation with which we are sometimes faced.

Last week we had another area clinic call us about one of their clients, apparently because we are a large practice with several area satellite locations.  The client had a dog that was suspected of having an intestinal foreign body and they didn't have any money.  Care Credit had declined them and they were hoping that we might be able to help out with our charity donation system.

Quick aside....My practice has a fund that clients can donate to and for which we do periodic fundraisers.  We use the money in this fund to help people that really don't have the money to treat their pets for a serious condition.  To make sure that the truly needy get this money we have means testing, have to make sure that they have first applied for and been declined for Care Credit, and the client must contribute at least a little money to the care.

The client came to us for more information, bringing the dog.  We quickly learned that their combined monthly income was above our required threshold and we couldn't use our funds for them.  I examined the dog as a courtesy and talked to them.  The dog was a sweet American Stafordshire terrier and seemed depressed even though I had never seen him before.  The client said that he was known to chew on and eat objects around the house and just last week they had found a pair of underwear in his feces.  On his exam I noticed that he was uncomfortable when I put pressure on the upper right part of his abdomen.  This can mean pancreatitis as well as something obstructed or inflamed, so with the client agreeing to a minimal cost we did a quick test of a pancreatic enzyme.  This came up normal and considering his history I had to conclude that there was a very strong likelihood that he did indeed have something stuck in his stomach or small intestine.

Normally if we suspect a gastrointestinal foreign body we want to start with x-rays.  Softer objects blend in with the surrounding organs so cloth may not show up well.  In these cases we do a barium series, forcing the pet to swallow a non-toxic metallic liquid and taking a series of x-rays to watch the passage through the digestive tract.  A basic set of radiographs costs around $175 and a full barium series is around $450.  

In a case like this I would be willing to just jump to surgery as long as the client understood that we were taking some risks by not having a definitive answer beforehand. A very simple intestinal surgery costs around $1100-1500.  If we have to remove part of the intestine or there are any complications it can quickly top $2000, not including any overnight stays at an emergency clinic for monitoring.  If they went to a specialist they could easily pay over $4000 for the same surgery.

As I talked to the clients I learned that they both worked and had no money.  From the conversation I gathered that they had had their home foreclosed upon and their cars repossessed.  They were truly in dire needs with no funds. I truly felt bad for them and for their dog.  But there was nothing we could do to move forward with the surgery.

"Well, then you should have done the surgery!  If you really loved animals you would just do it!  You should worry about payment later!"

That's a nice sentiment, but it doesn't work out that way.  Remember that this client had no money.  They had such poor credit that they had been declined a credit line, meaning that they were unlikely to make regular payments.  Our clinic does have a charity fund but we limit it in certain ways to make sure that money isn't given out too often, thus depleting the fund for people who truly need it.  In this case we only had $2000 in the fund, which if used would have prevented us from helping anyone else for a while.  There was also no guarantee that the dog would survive surgery

As I've mentioned many, many times, we can't give away services, especially expensive, risky ones like this.  If we did that we wouldn't be able to stay open.  "But this was a special case!  You should have made an exception!"  To the pet owner, every case is special.  It's hard to say to someone "well, we made an exception in the last case but we can't do it in yours."  If everyone was an exception we'd run out of operating costs and have to close our doors.

These cases are heartbreaking.  It's times like this that I really wish I didn't have to worry about the money.  But the utilities companies, drug companies, and my employees aren't going to be very understanding if I say "I'm sorry but I can't pay you this month because I helped out a few clients who were in need and I'm short about $4000."  My power would get shut off, the distributors would stop selling to me, and my employees would quit.  I have to pay other people, so I have to expect people to be able to pay me.  Believe me, profit margins in veterinary practices aren't high and we're not rolling in dough.  It's not being money-grubbing, hard-hearted, or anything else that I'm sure my critics will throw at me.  It's simply part of the reality of life.

I offered euthanasia but the client wanted to take him home that night.  I never heard back from them so I don't know if they found money, had the dog put to sleep, or he died.  My heart really does go out to them.  Sometimes bad things do happen to good people.


  1. Dear Chris,

    realising that with pets come unforeseen veterinary costs is reminder for me to monthly put money aside for my cats and dog. I am a student Para veterinary and work fulltime next to this, and as the only one responsible for my critters, I still take great joy everyday in putting aside 10 euros worth of fresh meat for my animals rather than spend it on a complicated cocktail in a bar.
    I was thinking about the fact that cat and dog food gets sold in the supermarket, makes owning pets easier and maybe less thought-requiring. For me it is more, it is a lifestyle, whereas my friends go to Sri Lanka, I enjoy the companionship of three healthy, well taken care of creatures.
    Sadly sometimes financial fate cannot be forecats :(
    Thank you for your blogging and for sharing your experiences, I am a loyal reader.

  2. Adrienne, I appreciate your comment. Coming to terms with the reality of this dilemma has been one of the hardest processes for me as a veterinarian in training. Your comment, however, strengthens my resolve even more.

    Budgeting money for a pets care is an important part of being a pet owner. Giving away services to those who have not done so does a huge disservice to those who do, like you. I don't mean to judge Dr. Bern's clients - I don't know about their situation. But in general, I think many people who can't pay for veterinary services can't pay because they have made other priority choices with their money in the past.

    Furthermore, it's almost impossible to tell the difference between someone who truly CAN'T pay for their pets' care and someone who WON'T. For some people, I think, "I don't have any money" might mean "I have $2000 in the bank but I've been saving it for a new flat screen TV". Some people have the money, but they think $2000 for a surgery is too expensive and don't want to pay it on principle. They know they won't get the price reduced by saying that, though, so -- "I don't have the money". Those are extreme examples, of course, and there are many many people who are truly in need of help. But it reminds me how hard it is to give services away to one person while turning down another.

    Thanks for the post Dr. Bern.

  3. I really appreciate your willingness to post this, knowing there won't be people who understand. I pray you won't be hit with anything like that anytime soon!

    When my kitty was younger, he had several urinary tract obstructions, due to developing crystals in his urine. We tried dietary modification and other stuff, but it recurred twice. We had to make trips to the emergency clinic with him. (Ever notice how it almost always happens on weekends?)

    Because it made him miserable and was dangerous for his health, we agreed that if it happened again, we would go ahead with surgery . . . and it did, so we did.

    At the time, I was in college, and we were pretty broke. But we did it anyway, borrowing money from my in-laws. (They adore the cats, and offered.) In the end, we knew it was our responsibility to take care of him, since we took him in.

    Fortunately, we now have a bit of an emergency fund. If it ever happened again, we would be in a much better position.

  4. I have often heard "if you can't afford the vet, you can't afford the pet." And while I can't completely agree with that (sometimes you fall on hard times, and you can't foresee all emergencies) I do agree that you have to make sacrifices for the well-being of your pet.

    If it means I don't get the latest style of cell phone, or the nicest clothes--so be it. My cats will have the food they need and the medical care they require long before I get something frivolous.

    When my cat was obstructed I had a $3000 bill--it was heavily discounted, almost 50% to a little over $1600 due to my job as a technician, but it was still a huge outlay for me. I did not balk at it, but simply gave up going out to eat for several months, and paid the minimum on my credit cards instead of the full amount each month for a while.

    You can find a way to do it if you really want to--if you really care about your pet, you won't put that burden on your vet.

  5. We had a somewhat similar scenario at the clinic I work at (I'm a Vet Tech) last week.

    Instead of an intestinal obstruction, our patient was a 10 year old dog with a pyometra. The 2 hour long appointment ended in euthanasia, which was an understandably difficult decision for the client to make. It didn't help that his wife was yelling through the cell phone "so what, you don't have money so they will just let your dog die?!"

    Thankfully the client (husband) understood that we could not preform the surgery (it was already after 6pm) and the dog would need to be stabilized at the local e-clinic first, and there was no guarantee that even with all the money in the world, his dog would live.

    It is incredibly frustrating that clients assume all of us are in the field for money, and that everything should be free. Especially when most of these cases seem to be the preventable problems like heartworm disease, parvo, pyometra, etc. A little client education goes a long way! This is why I am considering a career in Public Health vs Companion Animal!


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