A dead puppy, a hostile client and a potential zoonosis: What to do?

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How was I to know an erroneous report on an Atlanta news station a few weeks prior would turn my Friday upside-down? I don't even watch the local news in Detroit where I live because, frankly, I have things to do. But then my office received an angry call from a client. She told us her 3-month-old puppy was dying because of the poisoned heartworm preventive we'd given him last week at his second puppy visit.

It's hard to know where to start with an accusation like this. My first reaction was that this was a safe preventive we'd been using for a year and a half. In fact, I'd given it to my own dog just days before. But I knew we had to do our own research to connect the dots.

When the puppy had presented to our hospital he looked great. There were no abnormalities with his physical exam; he received his second parvovirus and distemper vaccines and a second heartworm, intestinal parasite and flea preventive. The following week the puppy vomited a few times and the owner called us. She stated at the time that he was bright and alert and decided to keep an eye on him.

Unfortunately on Wednesday she came home from work to find the vomiting had worsened and the puppy was now lethargic. Because we were closed on Wednesdays, she took him to a hospital across town, where they ran blood work to find he had a severe azotemia. He was hospitalized and put on intravenous fluids, but he worsened and was euthanized two days later.

The veterinarian at that hospital told the owner that his practice had received reports of problems with this heartworm medication, and so the owner seemed to have her answer-her puppy was given a known toxic drug by us and it had killed him.

Here's what really happened: Several weeks earlier three puppies had suddenly died in the Atlanta area. Before they got sick these puppies were given the same heartworm preventive. So the owner and her veterinarian concluded that the heartworm preventive was at fault and it was their duty to take it to the air.

The drug manufacturer caught word and for the quality of its product and good name paid for an independent necropsy on the puppies. Turns out all three puppies (which were littermates) had a congenital heart defect; their deaths had nothing to do with the heartworm preventive. But by the time the facts were settled, thousands had seen the Atlanta news report and many more across the country were reading bad things on the internet or receiving misinformation from their own veterinarians.

Back to my Friday crisis with my angry, heartbroken owner. Certainly sympathetic to the terrible situation, we offered our condolences and asked what we could do. The owner's response was that we could do whatever we liked but she would definitely be suing us. We were confident she did not have a case, and I'm sure a lawyer would have recommended ending the relationship right then and there.

But I still wanted to know what had happened. A young puppy that had been perfectly healthy a week earlier became acutely azotemic and was euthanized within two days-that's all I had to go on. There were many possibilities, but the one that concerned me most was the possibility of leptospirosis, which is endemic in our area. My thoughts turned to the 1-year-old child who'd been in the exam room with that puppy a week ago.

Despite the client's threats and hostility, I had to think of that child's health. So I discussed my concern with my practice manager. My manager had the same concerns I did, and against legal advice we decided to get answers on this case, if for no other reason than the potential health of the child.

We could have done a gross necropsy ourselves and sent the samples to reference laboratories, but the owner had totally lost trust in us. We told her the best option would be to get an independent, board-certified analysis and take the puppy to the nearest university diagnostic lab, which was about an hour and a half away.

The owner balked at the price. So then my practice manager had a great idea-he called the manufacturer of the heartworm preventive in question. And although neither the company nor we really believed the preventive was the problem, the company agreed to pay for the necropsy.

Unfortunately the owner still refused, not wanting to make the drive. So my practice manager, for the sake of ensuring this child's well-being, drove a half-hour in the wrong direction to pick the puppy up, then drove to the university to have the necropsy performed. He literally spent that entire Friday dealing with this case.

Luckily the leptospirosis tests were negative. All toxin screens for the heartworm prevention were negative as well. The puppy had died from an acute enterococcal renal and brain infection.

It took about six weeks until all results were in, and after each report I called the owner to discuss. The leptospirosis test took some time, and as we waited the owner was becoming concerned about the disease as well. The one time she answered the phone when I called (every other time I left detailed voicemail messages), we discussed possible implications of leptospirosis, and I advised her to talk with her pediatrician and get infectious disease specialists on board if the results were positive.

During our conversation I could tell the owner was more concerned about her family than about litigation, but I could still tell that she distrusted us because of that initial misplaced information. Luckily leptospirosis was not the issue and the issue died down.

In the end we lost a puppy. We went through a lot of trouble for a client we were not going to keep. But I am proud of the way our hospital handled the case and looked into something that could have had broader human health implications-for a young child, nonetheless. Our diligence did not make good business or legal sense, but I truly believe that we were the only ones truly looking out for this client's family even though she did not appreciate it. Sometimes beyond your better judgment, you just have to do the right thing.

Dr. Andrew Rollo is an associate at Madison Veterinary Hospital in Detroit, Michigan.