Wednesday, December 21, 2011

Another rock and hard place story

I was confronted with a very difficult situation recently. It was difficult on many levels and forced me to make some hard decisions. One of the major ones was finances, as it always tends to be.

I was presented with a less than 1 year old, female Labrador retriever. This Labrador was DEPRESSED. She could barely lift her head, and she noticeably winced when I palpated her abdomen. She'd been vomiting for 24 hours, unable to hold anything down. On a rectal exam, there were absolutely no feces in her colon. She was extremely dehydrated. Everything told me that she had a foreign body. Xrays confirmed it. Not only was it a foreign body, it was the nastiest of the nasty: a linear foreign body. Her intestines were bunched tightly on each other - like a tightened drawstring.

Sighing, I went to deliver my recommendation for surgery to the distraught owners. They'd come through the doors with zero finances and had applied for CareCredit right away. They were really nice people, and they owned a really nice dog. That automatically equals a bad scenario...it's one of those stereotypes of ER medicine. Nice owner, nice pet = bad disease.

At any rate, given how sick the dog was, I suspected that the linear foreign body might have already poked a hole in his intestines. Surgery was indicated right away. I made up an estimate - being as conservative as I could (no pre-operative bloodwork, etc). The low end was $1600. The high end was $1700. This was being CONSERVATIVE, mind you. Really and truthfully, the estimate should have been at least $2100-2500.

They were approved for $1500 only with CareCredit.

My options? 1) Doing the surgery knowing that it would cost more, charging them full price, and billing them 2) Doing the surgery and discounting the bill steeply 3) recommending that they wait until the next day to see their regular veterinarian so that they could have the surgery done cheaper (but risking the dog dying and/or the internal scenario worsening significantly overnight) or 4) euthanasia.

These people were nice. They applied for credit, as we'd requested. They got a stout $1500 approval. It still wasn't enough. If they waited on surgery, the dog would either die or be in a much, much worse situation by the time surgery was conducted. If they did surgery with me, it would be much more expensive than $1500. Further, it would leave them NO funds for transfer to the day veterinarian. The dog would not be able to go home in the morning; it would have to go to a day veterinarian, which would also cost money (all of which I would've spent).

What to do?

What I did was gave them the $1600-1700 estimate, deciding to roll with whatever happened. Of course, it was the worst it could possibly be. There was a small hole in the intestines. There was string/fabric throughout the small intestine. It was a long, frustrating surgery. I had to make 5 enterotomies (openings in the intestines), cut out about 3 inches of intestine, and open the stomach. Instead of taking me the projected 1 hour it generally takes me, it took me a full 2 hours. I knew this dog would have a long and rough recovery with a high chance of dehiscence at one of the sites, at least.

The final bill was $2300. I deducted that down to the high end of the estimate - meaning I knocked off $600+. Further, I stayed after my shift by about 3.5 hours to do this difficult surgery. Time I could've spent with my daughter, who I'd barely seen over the last few days due to my work schedule. Lastly, I made no money on that surgery. Deducting the $600 meant that I deducted off my production. Thus, I spent 3.5 hours of my own time on that dog.

And yet, people call vets money-grubbing.

The patient had a rough recovery and spent 9 additional days in the hospital with his veterinarian. I called to apologize for sending a new patient (the owners had just moved into town) to this clinic with no money. I'd spent it all. I had to. I had to cover the expense of surgery (i.e. doing it at cost), since I was not free to give away clinic supplies.

It was a very difficult and frustrating scenario, but the dog is alive and home with the owners' young daughter for the holidays. That's what matters to me.

11 comments:

WeldrBrat said...

By the time you look back 20 years and think about this particular situation... you will have conversed with hundreds..if not, thousands of other Veterinarians that will have gone through the same agonizing predicament.

I wish animal owners were educated about the impact from the healthcare industry that is bleeding over into the Veterinarian field. It was already sad, the fact that humans have never quite valued their animals as highly as themselves... unless they can get somebody to heal them for absolutely free.

Hon... toughen up. And don't let this cost you what's most important... the short time you really do have with that baby.

Bottom line...the cost for everything is going sky high. Nobody should own animals if they can't afford to pay for their medical care. Too many folks have cats and dogs that they aren't caring for, properly. Yet, they're worrying about money for their own groceries. I can only assume their minds have gone awol.

iris said...

To comment on the previous poster...I agree people that don't have the money should not get animals. But right now I think it's less of that happening, and more people who WERE previously financially secure, having lost jobs or whatever that makes them unable to pay for what they need.

We have three dogs. Previously, we would've pretty much been able to afford everything they needed. Then my Dad lost his job. We lost over half our income. 90% of my money goes to the house payment. Right now? No, we can't afford to take the best care of our dogs. Does that mean they go hungry, don't get vaxed, no. But if something major would happen..it'd be a depressing situation.

Anyways, off my soapbox.

The Nurse said...

Your story brings tears to my eyes, for many reasons. Thank you for what you did for that dog and her family. Your daughter is blessed to have such a kind, giving, and compassionate mom....know that she will know that some day and love you all the more for it.

:)DAB

Elizabeth said...

We don't all say Vets are money grubbing.. many of us truly appreciate all our Vets do for us and do our best to show it. You did a good thing for this dog and his family. That is something to be proud of.

Nicki said...

That was very sweet of you. Glad it turned out well and hope the owners were very thankful.

The Homeless Parrot said...

Iris, while people in your family's situation are certainly accounting for more and more of my clients, they are still not the majority. The majority of the people I see are entitled and expect free veterinary care for their pets.

iris said...

Sorry HP - I wasn't insinuating that it was. :) I do see a lot of people who think that they deserve everything for free or little work, and it's not even just veterinary care...I work with biological parents who have lost custody of their children and so many just don't care enough to do everything that they need to do or they're more focused on getting high.

I was responding more to WeldrBrat. :) My family isn't awol, just currently out of luck. Considering I'd like to go for my Ph.D, there's not much I can do to help, as sad as it makes me. :/

Laura Potts said...

I am so impressed with your heart and dedication to our pets. Please know that your hard work and time put in are greatly appreciated!

Anonymous said...

I disagree with WeldrBrat's comment that people shouldn't own animals if they can't afford care, because that doesn't recognize a spectrum of philosophies about how much care an animal should GET. If my value system is that I provide a pet cat with food, water, housing, and annual preventative care, but that's it (meaning in a critical-care situation the animal would likely be euthanized); then that's ok. There's no moral obligation for owners to provide the highest level of care feasible. If you take the approach that people without high amounts of disposable incomes shouldn't own animals -- we'll have a lot more homeless/feral/abandoned animals. And that's to the overall detriment of the animals. So while I appreciate the sentiment, I think WeldrBrat's conclusion is misplaced.

I've provided volunteer care as a student for people who take generally good care of their animals and the animals largely have a great quality of life (as well as providing great companionship for their owners). I don't think it's reasonable to suggest they shouldn't own the animals simply because a $2500 treatment is out of reach of their budget.

Lastly, and to Homeless Parrot, do you ever consider extending partial credit? Like in this case, would it be possible to charge the full amount, take the $1500 immediately, and then allow the client to pay off the rest over time? Obviously vets are not banks, but in a situation where the client can cough up part of the money ... is it ever worth it to allow them to pay the rest over time?

Seems to me that in a case like this one you have nothing to lose (if you're planning to go ahead and do the surgery anyway). Look at it this way: You did the treatment for $1500 and lost money (or, at least, didn't make any). Had you charged them $2100 but allowed them to pay the add'l $600 over time ... maybe they'd pay and maybe they wouldn't, but in the worst case where they don't, you'd be no worse off than you are now. Right?

I'm dreading these situations when I get out of school.

The Homeless Parrot said...

Anon re: extending credit. Honestly, we have extended credit in some situations in the past. It winds up being such a hassle. Most people don't pay. They are perfectly willing to pay when the animal is in dire need of care, but once the animal is home, the need to pay the bill becomes secondary.

I've seen it happen over and over again. And sincerity doesn't seem to predict whether people will pay. I've met some of the sincerest people in my job...at least, I thought they were. And then they don't pay. And we wind up mailing letter after letter, then certified letter, then court, etc. It's just not worth it.

The Homeless Parrot said...

Anon re: extending credit. Honestly, we have extended credit in some situations in the past. It winds up being such a hassle. Most people don't pay. They are perfectly willing to pay when the animal is in dire need of care, but once the animal is home, the need to pay the bill becomes secondary.

I've seen it happen over and over again. And sincerity doesn't seem to predict whether people will pay. I've met some of the sincerest people in my job...at least, I thought they were. And then they don't pay. And we wind up mailing letter after letter, then certified letter, then court, etc. It's just not worth it.