Sunday, April 29, 2012

If you read my last post, you will hear about Snook - a dog in which I possibly missed an important diagnosis.

The owner wants a refund of his money, and honestly, I am torn over what to do.

Snook did die, yes. When he left my clinic however, he was completely stable with normal vitals. His back hurt, yes, but he had no signs of imminent death. I have double and triple checked the medications he was given, in the event the I had overdosed him, but that is not the case. No, Snook died from something else.

The owner claims we killed his dog with an overdose. When I explained that it was not the case and went over the medications with him, he switched tactics. Now he is claiming that he had no idea prior to leaving the clinic with his dog that Snook would die.

I can't argue with him. It's true. Even I had no idea Snook was in any threat of death, or else I never would have sent him home.

Here's my problem(s). Medicine is an art and not a science. IF Snook died from meningitis, a spinal tap would have been necessary to diagnose it. This would only be done by a neurologist. I did offer referral, but the owners, thinking the back pain and seizure activity were separate (as I did) elected to wait on this. Once Snook died, the only way to confirm what caused his death would have been a necropsy (animal autopsy). The owners did not pursue that and instead buried him.

Thus, I will never know for sure what killed Snook. My guess is meningitis, but truthfully, I have no idea. Whose to say that Snook didn't go home and get into something toxic?

My husband made a great analogy. It's like taking your car in for a transmission repair. You pick it up, drive it for half a day, and then it dies. Instead of taking it back to the place where you had it fixed, you sell it to the junkyard. Then you ask the repair place for your money back.

Was it a faulty transmission and poor repair? Possibly. Is there any way to know for sure? Absolutely not.

Thus, I am stuck. The owner wants his money back, but his reasoning is unclear. I am very sad that Snook died; I feel terrible. Did I miss something? Quite possibly. But there is no way to know for sure.

What I do know is that I sent a dog that looked stable and mostly healthy other than neck pain out the door only to hear that he was dead 8 hours later.

What do y'all think?


Suzanne said...

It's a hard decision. Your husband is right on the analogy and the owner would be hard pressed if he wanted to take you to court because he did not do a necropsy.

My thoughts would be this, is the owner a repeat customer?

I know you work at an Emergency Vet, but we made sure that the two times we have had to use ours that we left a good impression and got to know the staff. If he/she is I -might- opt to refund half or some other percentage of their money just for good customer relations.

If they are not and this is the one time you have seen them, I would probably not give them a refund.

Honestly, you don't really know why the dog died, and because of the owners actions, you will never know for sure. Vets are not infallible, mistakes happen it's what you do afterward that makes all the difference. The truth is, another vet could and probably did make the same mistake you did. So you shouldn't bear all the blame.

Soon to be Dr. T said...

I don't think you should give the owner his money back unless there's proof that your actions led to his death. Is it possible that he died from meningitis and you missed it? Yes, but you don't know with absolute certainty that's why he died. Like you said, for all you know Snook got into something toxic after he got home. Even if he died from meningitis, that doesn't change the fact that you used your time and expertise to evaluate him and give the owner your medical opinion and medications.

I went through something similar to your pet owner and never even considered asking for a refund of my money - my six month old cat died from FIP and the first clinical signs she had were weeping eyes and a fever. We know she had feline herpes and she got worked up and treated for a severe herpes outbreak. No one even considered FIP a possibility until after she died and we considered how she started to get worse rather than better the last few days. I never blamed anybody (but myself) for not realizing that something more serious may have been going on because there was a logical reason why we thought herpes, not FIP to start with. These things happen and it's not your fault. You're human.

Anonymous said...

Yes, maybe you missed something, but not on purpose and your intent was good. It happens in human medicine too- no one gets their money back there. When you give consent for treatment, you consent to pay for said treatment of your pet- regardless of the outcome. You can't know for certain it was your fault but I wouldnt be inclined to return the money (easy for me to say that though, it's not my case). Maybe a small voucher for future treatment of a new pet? Also, to me, giving a full refund seems a bit like admitting it was your fault (which it wasn't as you don't know definitively what caused death). Just my 2 cents.

Elizabeth said...

We have certainly all heard stories of people who had physicals and then dropped dead the next day. You are as they say between a rock and hard spot. Without a necropsy what the dog died of is a guess at best.
If the owner really wanted to know he would not have just buried the dog. When people ask for their money back it always makes me wonder. If he had brought the dog back and asked for a necropsy that I could see doing and doing it for free just to settle things and ease "YOUR" own mind if for no other reason.

Dr.M said...

Do not refund their money. Are you going to give back or not charge everyone else that brings an animal to you which then dies later on? No. As you said, you can't know for sure what actually killed this dog. And the owner has made it impossible to ever find out. You did what you could and they paid for your service. That's that.

Dr.M said...
This comment has been removed by the author.
Anonymous said...

As a dog owner myself I say no on the refund . Sounds like the owners are grieving and just looking for someone to blame .

Anonymous said...

Dad is just greiving, and looking for someone to blame. You don't owe him any money, just sympathy and support. If you had treated the dog for meningitis and he died would you give dad his money back? What if dad and pup got into a car crash or something similarily tragic on the way home and the pup died - would you refund then? Without a necropsy, its hard to know for sure what he died of. 99% of the time this dog would have gone home, had a few stiff days, and been perfectly fine. Its easy to miss the zebras, and you only feel bad because you are a good vet that wants to learn from mistakes.

Holly said...

"He'd been seen at his vet a week prior for neck and back pain. Therapy with standard anti-inflammatories, pain medications, and muscle relaxants had not relieved his pain at all. In fact, the owners reported that he was worsening, despite his medications."

the owner waited a week before making a choice not to go back to his own vet. Had this been me, and there was no relief in 24-36 hours I'd have called my own vet back and gone there again. What this owner did was wait too long. YOU can't help that.

I would not refund his money.

Ribbit said...

Do not refund. You did all you could. Sometimes bad luck happens, and it is no one's fault. People don't understand that. There doesn't always have to be someone "to blame" for every bad thing in the world.

Anonymous said...

You offered the option of further tests to the owner. He refused the tests. Maybe if he had agreed you would have had a better idea of what was wrong. Is that your fault? No, it isn't. Should you refund? I feel that you shouldn't, especially as there is no way to tell what happened to the dog as the owner rather hastily removed the evidence.
What a horrible situation for you though.

Kerrie said...

I also agree that a refund is not necessary. I could understand if it really was an overdose issue, but you know for sure that it was not.

I remember when my pop-pop went to the doctor's on a Friday and the doctor told my Pop-pop that his heart was healthy as a horse; my Pop-pop died of a massive heart attack 3 days later. While the family mourned we looked for answers and couldn't help but ask each other how that doctor could have said that and then his heart gave out. But once we worked through our grief we knew that the fault did not lay with the doctor or the tests, it was other stressors in his life that just took a toll on him and it was his time to go.

I think once this client works through his grief he will no longer be looking to lay the blame on someone.

sara said...

On October 25th of last year I had to put my yellow lab down. This is after 2 weeks of mis-diagnosis at the ER vet. I say that lightly though, the original diagnosis was based on my observations at home and made sense (blockage due to eating something he shouldnt). X-rays confirmed blockage although after a day it was cleared without him passing anything. Next thought was pancreatitis. After treating that for a few days and not getting better the diagnosis changed to prostate cancer. At this point my friend was suffering terribly and I chose to euthanize. Is that what he really had? I dont know, I know being a neutered male it was an unusual diagnosis. I read about it afterwards and certainly agree the symptoms fit. I'm rambling but my point is that I know the vet did everything she could and whether she mis diagnosed him or not the outcome was the same. I did not ask for nor expect any type of refund.

Chris Bern, DVM said...

Like everyone else has said, don't give a refund. Too many people in today's society look to blame others rather than accepting their own responsibility or that things just happen.

Would you have felt comfortable doing a spinal tap? If so it would have taken several days for a culture and sensitivity to give results. Referring to a specialist would have been great if the owner allowed, but also would have taken more time than the dog had.

Did you possibly miss something? Yes, that may have happened. But everyone out there has miss something in their job. You're not God, you're not omniscient, you don't have a crystal ball, and you're not going to be right 100% of the time. You did everything you could have and made the best decision with the information available. Going to a vet is no guarantee of a cure or even full diagnosis. You owe this client nothing beyond your sympathy.

Mel said...

First year vet student here --> really enjoy your blog.

I don't think you owe him a dime. It is very sad. Unfortunate. Terrible. but, I agree with the car analogy.

I think I would feel differently if the dog died and the owners called you up, concerned that you did wrong/missed something. I think at that point offered to pay for a necropsy, if they were willing. Or, if they already had a necropsy done and there was some proof that there was an overdose, again I would consider some sort of monetary compensation etc......BUT it remains that a necropsy was NOT done, there was no malpractice...thus I would be hesitant to give money just because it was an unfortunate occurance and I felt bad and I was being pressured.

When my horse died of colic, despite treatment, the vet clinic offered to do a necropsy free of charge. I gratefully accepted and really appreciated it. I did not expect a refund of any monies just because she died under their care.

vets1173 said...

I'm a vet with 13 years experience. You did exactly what we all would have done in the same circumstances. You told them referral was needed--they declined. It is not your fault, and they do not deserve their money back. There are things that cannot be diagnosed in general practice, this was one of them.