Ethics question, Veterinarian related

[stomachmonkey]

I have 4 cats.

Over the last year have spent a sizable chunk of change on two in particular.

Couple of grand on Iodide 32 treatment for hyper thyroid on the 12 year old male and couple of weeks ago he cracked a tooth to the tune of $500.

Hematoma on the 3 year old males ear.

The 16 year old female Casie, is the issue.

Her history, couple of years ago she became incontinent. Our old vet in NY diagnosed it as a thickened bladder from multiple UTI's.

We tried everything the vet recommended and my wife even took Casie to a holistic vet for a acupuncture for a few weeks.

We contemplated putting her down before we moved to TX but were not read to give up on her yet.

We had her crated in the rental while the new house was being built.

The new vet down here said the cat was stressed and put her on Prozac which worked.

Then Casie got breast cancer last year and we tossed a big chunk of change at a mastectomy that the vet figured would buy her a couple more years at most.

About 8 months ago Casie went deaf.

5-6 months ago the vet diagnosed her with dementia/Alzheimers.

2 months ago we took her in for a $25 grooming and my wife mentioned the cat had been drinking a lot of water and the incontinence issue was returning.

So $600 later Casie is diagnosed as diabetic and we now need to give her twice daily insulin injections.

Here's were the issue starts.

Vet wants the cat back in for a series of 6 insulin level tests. Wife is flipping out over all the unexpected costs and tells vet to do 3 level tests. I pick up cat and they tell me that morning level was X, noon level went up, evening level went up but they don't have an accurate picture and want her back the next day for the 6 level tests. Then they tell me I need to buy a glucose meter and test strips from them for a few hundred more.

I respond that the wife and I have decided that we will do what we can to keep Casie comfortable but we are not shelling out all that cash for a cat that may not make it another year. I also expressed how irritated I was that they agreed to only 3 tests knowing it was useless and if we had not wanted to pay for the 6 tests then what makes them think we'll pay for 9?

Last Sunday wife and I leave for a cruise. My in laws came into town to watch the our kids, house and cats.

Not wanting to burden them more we decide to board Casie for the week.

Wife prepays the boarding fee, fee for a tech to administer twice daily insulin and brings more than enough cat food for the week. She leaves instruction on how much to feed.

My F-inlaw picks the cat up this past Saturday and in addition to the pre paid agreed to fee's there is a charge for the 6 level tests, 3 additional cans of prescription cat food that are 3x's more than costly than what we feed and $40 for a case of the food which they hand my f-inlaw to bring home.

So the bill is $120ish more than we prepaid and they billed our credit card for the extra.

They did not call anyone to get authorization for the tests and they knew from last month that we had an objection to it.

The only reason they would have needed to give her the prescription food is they ran out of her regular food which means they ignored my wifes instructions and over fed her.

Now the test and over feeding I can almost justify. She is in their care and they should be trusted make care decisions as is prudently required for the animals well being.

But they did not call for a consult or get permission to bill our card any additional amount other than what we had prepaid for the agreed upon services.

The $40 case of cat food sent me over the edge.

So I am going to call today and get the test charges removed and return the food.

I'm pissed.

Did the vet have the right to do any of this?

[deanp]

If they were monitoring the cat and felt the need to run tests, change the diet or do any other procedures while she was in their care they should have called you and gotten authorization. I would have a conversation with them not only about the charges, but the disregard of the feeding instructions for a diabetic pet, as well as the lack of communication.

[Tobra]

No they did not and no that is not ethical. You need a new vet. I would call the state on them and also call my CC company about getting the charges reversed.

[nynor]

wow. some folks really baby their cats.

fwiw, cats are the one (and only, i think) animal that can recover from diabetes. somehow, their pancreases just kick back in. not always.

that said, with that many health problems, a good dose of barbituate for that poor animal may be exactly what she needs.

[island911]

was there some sort of boarding agreement? ....something that gives discretion to the doc's to keep your pet alive until you return?

I imagine a lot of people would be PISSED if Fluffy was just left to die in a cage because no one was around to authorize $40.

[stomachmonkey]

Just got off the phone with the vet.

He says the cat was urinating excessively so they thought something was up and did the tests. He did try the, it's in our care so we are obligated to care for them angle.

He response was similar to Glens reply. That they have had episodes where clients complained that they "should have done something"

I agreed with him and reminded him that we are not discussing a cardiac episode or the cats head falling off. Not a situation that required immediate action. If that were the case then I would not have been surprised that they provided the necessary care. The cat was there for 5 days before they ran the tests, the day before she was scheduled to be picked up. One day was not going to make a difference.

I told him the only reason we are discussing it now is due to complete lack of communication on their part, that his office made no attempt at all to contact us. We had no missed calls on our cell phones and my wife checked the call log on our home phone as soon as she saw the bill, no calls. He pulled the assigned tech in and she admitted that she did not try to contact us.

Originally Posted by island911

was there some sort of boarding agreement? ....something that gives discretion to the doc's to keep your pet alive until you return?

I imagine a lot of people would be PISSED if Fluffy was just left to die in a cage because no one was around to authorize $40.

The $40 was for a case of prescription cat food that in his opinion is better for the cat and he ran that plus the test costs on our card without permission. It's like your wrench deciding to use Unobtanium oil that's 3x's the cost of what you normally use cause he thinks you should be using it.

[Mothy]

Originally Posted by stomachmonkey

Now the test and over feeding I can almost justify. She is in their care and they should be trusted make care decisions as is prudently required for the animals well being.

That says it all to me (plus what Island911 said) - you left the cat in their care. The Vet's primary responsibility is to the animals in their care. Whilst you as the owner have a say in the level of treatment you can afford, the Vet will be recommending the best option for the cat. Don't know why you felt that 3 level tests would be OK when the Vet recommended 6 level ones. Pehaps they should have pushed back and said the 3 level ones were a waste of time.

Sounds like you left the cat with the Vet's for boarding - yet you tell them how to feed it. You clearly love the cat - you have spent a small fortune on it over the years.

I should declare an interest here - I'm married to a vet. We have similar animal population - 4 cats adopted over the years (1 blind, 1 deaf with dementia, 1 very old and fat and 1 stupid as a rock), but at least we don't have the same bills.

I do agree with you on the $40 case of cat food though - take it back and get it elsewhere cheaper. Animal food from Vet's is nearly always a premium price.

[stomachmonkey]

Originally Posted by Mothy

That says it all to me (plus what Island911 said) - you left the cat in their care. The Vet's primary responsibility is to the animals in their care. Whilst you as the owner have a say in the level of treatment you can afford, the Vet will be recommending the best option for the cat.

Like I said, I understand that, but you call the owner. It's not a recommendation when you don't consult the owner.

Don't know why you felt that 3 level tests would be OK when the Vet recommended 6 level ones. Pehaps they should have pushed back and said the 3 level ones were a waste of time.

Told him I was pissed at my wife and him over that one. Exactly as you say, don't agree to treatment that you know is a waste.


Sounds like you left the cat with the Vet's for boarding - yet you tell them how to feed it.

The Vet told us to bring the cats normal food. As you probably know cats don't tolerate sudden diet changes that well. Especially when insulin balance is tied to diet. Wife told them how much the cat gets per day, half a can of wet and all the dry she wants which is exactly the diet that this vet had recommended to us a couple of years ago and we stuck to it.

You clearly love the cat - you have spent a small fortune on it over the years.

I should declare an interest here - I'm married to a vet. We have similar animal population - 4 cats adopted over the years (1 blind, 1 deaf with dementia, 1 very old and fat and 1 stupid as a rock), but at least we don't have the same bills.

I do agree with you on the $40 case of cat food though - take it back and get it elsewhere cheaper. Animal food from Vet's is nearly always a premium price.

Can't find the Science Diet KD at retail, wish I could. It's prescription, only sold by Vets

[RWebb]

different people have different levels of expectation about care for their pets, and ability & willingness to pay vary greatly

your vet may have just tried to give top quality care -- maybe

did the temporary pet caretaker ok the add'l treatment (hence billing) -- sounds like it, but not sure

I personally would not come down on them legally for this (complaint to VM Board) but I would talk to them. You are the client and you need to be clear on what level of care the patient gets (note those 2 are always separate in Vet. Med.).

They should volunteer to eat the extra costs tho. See if they do. IF not, you might dispute it with the credit card co.

[stomachmonkey]

Originally Posted by RWebb

did the temporary pet caretaker ok the add'l treatment (hence billing) -- sounds like it, but not sure

No, the Vet's office did not make any attempt to contact us or anyone else.

They should volunteer to eat the extra costs tho. See if they do. IF not, you might dispute it with the credit card co.

Spoke to him, he offered to adjust the bill however I see fit since his office neglected to make any effort at contact.

I'm not going to ask him to refund the test costs. Insulin is expensive. If we are not dosing the cat properly then it's a waste of money/we are spending money for no gain. Plus incorrect levels make her drink too much water which makes her incontinent. She's an old girl and uses the litter box just fine but sometimes she can't get there fast enough.

The food, not sure. It would be beneficial for the other Male with the hyper thyroid issue but it opens a can of worms.

All 4 used to get a high quality dry. Then Casie had some issues and the vet said to add wet food to her diet. If you have cats you know they prefer wet to dry. And try feeding them all different stuff. So now they all get wet as well as dry. All 4 go through a 24 ct. case of wet food in less than two weeks.

My wet food budget will go from $30 to $90 a month.

Casie, she really is a sweetheart.

[Mark Henry]

You don't want my opinion because I'm a county boy....and a new cat is dirt cheap.

[Red88Carrera]

Originally Posted by Mark Henry

You don't want my opinion because I'm a county boy....and a new cat is dirt cheap.

That's truly a SAD statement. We're talking about someone's family member! Let's show some compassion please!

My advice would be to pursue better communications and an agreement on the charges, or seek a different vet. Best of luck with Casie.

[pwd72s]

Damn. she's a beauty...and they DO worm their way into your heart. No advice here, just sympathy...

[stealthn]

So i have to ask with respect; do you think your cat's quality of life is good now with all the treatments and issues?

[Zeke]

Originally Posted by stomachmonkey

My wet food budget will go from $30 to $90 a month.

Casie, she really is a sweetheart.

Given the amount of money you have been willing to spend up to this point, I think you will buy the food and not complain. I also think you could slowly back down a bit on the ratio of wet to dry.

I have a cat, I understand.

[stomachmonkey]

So i have to ask with respect; do you think your cat's quality of life is good now with all the treatments and issues?

Actually yes. She's not in any pain. Going deaf was a blessing. When my kids and their friends are tearing around the house like little screaming banshees she's oblivious to all of it while the other three are hiding under beds.

She purrs all the time.

She seems quite happy and content.

Although it causes me grief every time I have always done the right thing when that time comes.

[stomachmonkey]

Quote de stomachmonkey

My wet food budget will go from $30 to $90 a month.



Casie, she really is a sweetheart.

Given the amount of money you have been willing to spend up to this point, I think you will buy the food and not complain. I also think you could slowly back down a bit on the ratio of wet to dry.



I have a cat, I understand.

I'm already there.

I think my real issue was the vets lack of communication.

When I spike to him I made sure to let him know that we thought he was a great vet and for sure casie and possibly the big male would not still be with us if not for him.

But they are my cats, if you want to make decisions for me without informing me then don't expect me to pay for them.

So maybe my real reason for calling was to reestablish the boundaries of our relationship.

[deanp]

Sounds like your vet understood your concerns. He's aware of the level of care for your pets in the past and probably was going to have a well needed talk with the tech.

[ddbach]

Good resource: Feline Diabetes —Diabetes in Cats — Treatment and Diabetic Cat Info — FDMB
Check out the part on home testing. My 15yo tortishell (Tori) has been diabetic for 6 years now. I test her periodically on an ear using a mini penlight to transilluminate the vessels along the edge of her ear. I do this immediately after putting her dish down. (Some cats won't allow this) She has done very well but does require twice daily insulin. Some cats can be controlled on once daily insulin. Talk with the vet on free feeding, that's probably going to change to get better control. Tori gets a pre-measured amount for each meal when she boards at the vet in little snack baggies (she is there now as I'm out of town for work). I feed
my other two cats in a separate room and shut the door for a while. Food is always better out of the other guys dish. Only hiccup recently was change in insulin brand as the one she was on originally is NLA. We had our first hypoglycemic episode (55) and I put pinches of brown sugar in her mouth until she was oriented enough to eat moistened dry food. Vet tech later suggested using frosting as it sticks together better and is cheap. If you are squeamish and hesitate the cat will sense this and will take control from you on injections and testing. Oh, an inexpensive glucosemeter form Walmart or Walgreens, etc will work fine for testing. I've done 3/day tests when first starting over weekends and just recently with the insulin change and much cheaper to do yourself.

[Mothy]

Glad you got it sorted with the Vet - as you said it was more a communications thing.

Nice natured cats are great companions and each has character. I fully understand the food bill issue - on top of the four cats I mentioned in the earlier post we have two Irish Wolfhounds.

Tim