The final bill

NATIONAL REPORT — A Syracuse, N.Y., television station opted to air a report critical of area veterinarians for charging owners to stay in the room during the euthanasia.

While the end of life is one of the most sensitive subjects veterinarians encounter, the balance between service and compassion is often a tightrope.

Charging clients who want to be present for their pet's final moments a little more isn't unheard of, says Dr. Dani McVety, owner of Lap of Love Veterinary Hospice and In-Home Euthanasia in Lutz, Fla. In fact, McVety estimates at least half of all veterinary practices charge more when clients are present during euthanasia. But the key is in the way the fees are communicated, she says.

"I have heard of this before. I see their point; I really do," McVety says in regard to practices that vocalize a charge for the pet owner to be present during a euthanasia procedure. "I completely understand where they're coming from. At the same time, I do kind of think it's a little bit sad that the client has to think they have to pay more money to be with their animal. They perceive that the procedure will be different with them there than without them there. I think it's a very dangerous thing for veterinarians to allow that perception."

Euthanasia is quicker without the owner present, McVety admits, and veterinarians are not out of line when it comes to expecting to be compensated for their time. But most practices will mask additional fees, mostly in the form of an intravenous catheter charge of $50 or $100 that is mandatory if the owner wants to remain in the room, rather than telling them they are being charged extra to stay with their pet.

"The communication is so important with the families and letting them know exactly what's going on," McVety says. "When I go and talk with veterinarians about how to make the euthanasia a little bit better, I highly recommend for them to not break down that payment."

Susan Wright, an office manager for True Blue Veterinary Health Center—a practice near the New York practice called out by the local media report on euthanasia fees—says her practice doesn't add room charges for regular clients and charges a single fee for the whole euthanasia procedure.

"We do not charge an office call, per say, when a regular client comes to the hospital," Wright says. "If we have a patient who we haven't seen for awhile or a non-client, we do a quality of life exam to make sure the animal should be euthanized."

But whether the exam is charged, Wright says all euthanasia clients simply pay a single fee for the euthanasia procedure plus additional charges depending on how they want the animal's remains to be handled.

"We feel it's important to let the client know we're there for them, and it's not about the money, really," Wright says. "Obviously we have to pay for our supplies and the doctor's time is all factored in, but it's not a time that we have to make money."

McVety says she recommends charging a single fee for euthanasia, like True Blue, but adds that the fee still needs to reflect the time and resources the procedure puts on the veterinary practice.

"Let's charge appropriately for what we're doing. It's an emotional thing," McVety says. "But these clients have so much to deal with, let it be one fee."

According to the 2011 edition of the American Animal Hospital Association's (AAHA) Veterinary Fee Reference, average total costs to euthanize a 30-pound dog ranged from $76.64 if the owner was not present to $80.87 if the owner was present. Regardless of whether the client was present, the average charge for preanesthetic sedatives was about $35, while IV catheter and placement was about $42. The average euthanasia charge ranged from $56 to $58.

Her services cost more than a traditional veterinary practice's, McVety adds, because of the additional time involved, but she believes it's something that more pet owners value. Potential clients who question her prices are referred to more affordable options at shelters and traditional practices, but often call back to schedule a home euthanasia, she adds.

"I explain everything to the clients, and I think they appreciate that," McVety says. "That's how they see there is value in what you do."

Having spent up to two hours at a client's home for a euthanasia, McVety says the average is 30 minutes. For a traditional practice, especially a small practice, that can put a strain on the hospital's need to service other clients. McVety believes in-home euthanasia may be the next big referral service in veterinary medicine.

"In my opinion, ask any veterinarian, receptionist or technician where they euthanize their pet. They always do it in the home. We always do it in the home. Why are we not suggesting this?" McVety asks. "Get it out of the hospital, let them grieve in private. They will heal faster, get a new pet faster and be back in your clinic."

Small practices have a difficult time offering home euthanasia services and may begin looking to outsource the job to someone who is available on short notice. McVety is just now looking into offering her services by referral to other practices.

"This trend is growing like you have no idea," McVety says.

Clients may see the option as an added value at a practice, rather than feel as though they are being left on their own to find a home euthanasia service or risking a less-than-perfect experience in a clinic if a home experience is what they need.

"Euthanasia must be done perfectly. If it is anything less than perfect, that client is going to be grieving longer," McVety cautions, adding that pet owners can be easily alienated during a euthanasia procedure. And it could be by no fault of the veterinarian. The client could hear the activity in the next exam room and become upset, or run into a family entering the hospital with a new puppy or kitten as they leave.

Veterinarians who avoid creating a negative association with their practice for the client will likely see that client back in their office with another pet.

For practices that would not consider outsourcing euthanasia, McVety recommends considering house calls or scheduling euthanasias when there are no other appointments.

AAHA emphasizes that making euthanasia less stressful for clients will bond them to the practice and make veterinarians and staff feel better about the task, too. Euthanasia is an area expected to generate a low profit margin, AAHA notes. Euthanasia already is a difficult experience for pet owners, the association explains, and a large bill may portray a lack of compassion or caring on the practice's part. AAHA recommends accepting pre-payment or sending an invoice after the fact, but notes that a conversation about fees should always take place.

"Money must be discussed at these times; it would be worse for the client to be surprised, but don't make it the focus of the conversation," according to AAHA.