Ethical Q&A: A laboratory goof-up and an unused cancer drug

Editor’s note: Recently we received these questions from a veterinarian who reads “The Dilemma” a dvm360 ethics column written by Marc Rosenberg, VMD. Do you have questions you’d like Dr. Rosenberg to address? Send them to dvmnews@advanstar.com.

Question: I have questions regarding two different ethical situations. The first involves a laboratory submission in which a portion of the tests were not run due to lab error. Because this error resulted in a three-day delay in reporting, the laboratory agreed not to charge for this portion of the tests. Should we compensate or refund the client for this portion of our charges?

The second situation involves a cancer patient that died before he was able to utilize a very expensive drug the owner ordered through our clinic. After this patient died there was no contact with the client regarding disposition of the unopened drug. Soon after, we had another patient that needed the drug. How should we have handle the charges for this drug for the second patient?

Rosenberg’s response

Answer: A professional, credible relationship between a pet-owning client and the veterinarian is the foundation on which a pet’s medical care is based. This relationship allows a pet owner to make what are often life-and-death decisions about their pets without fear of the veterinarian having ulterior motives associated with the recommendations.

These criteria are met when the veterinarian is open and honest about all facets of the pet’s veterinary care. With this premise in mind, let’s see how this applies to the reader’s questions.

In the first situation, the laboratory waived the fee for certain tests because it unacceptably delayed significant lab results. Laboratory fees charged to a client are usually made up of three components:

> the fee for procurement of the blood sample

> the fee charged by the outside laboratory

> the fee for the medical interpretation of the resulting information.

In this case, a refund of the laboratory fee component is in order, while the fee for the blood draw and interpretation should remain. In this way the veterinarian is compensated for services that have been rendered but can still return a portion of the total fee. The veterinarian suffers no financial hardship, and the open and honest relationship with the client is maintained.

The second situation is a bit more straightforward. Once again, an open and honest veterinarian-client relationship is the standard. In this case, the patient died before receiving one of the medications ordered for treatment. If the client was billed for this medication and it was not used for the patient, then the fee should be refunded. The obligation of the veterinarian would be to contact the client and inform him or her of the situation and refund any money paid for unused medication.

Most drug distributors will credit a clinician for the return of an unopened, non-expired medication. On occasion there’s a minor restocking fee, which can reasonably be passed on to the pet owner in this situation. In this case, a second patient was in need of this drug and the owner should be willing to pay the fee for the necessary medication to treat the pet. The veterinarian has suffered no financial loss, the patient has been served, and the open and honest veterinarian-client relationship has been maintained.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners. Send questions or comments to dvmnews@advanstar.com.