Letter to dvm360: Lets stop berating veterinarians who uphold medical standards

We are submitting this response to Dr. Marc Rosenberg's recent piece “Shades of gray in the veterinary-client relationship” for two reasons. First, the time has come to stop disparaging veterinarians for upholding medical standards. Second, it is time to stop ethically and morally burdening veterinarians when pet owners fail to exercise personal responsibility.

Dr. Rosenberg did not include the state in which Dr. Hanes, the subject of his piece, practices. But in Pennsylvania, the state in which Dr. Rosenberg attended veterinary school, the law states, “A veterinarian shall only prescribe prescription drugs to animals that are under the veterinarian's care. ‘Under the veterinarian's care” means that the veterinarian or one of the veterinarian's licensed associates has examined the animal.'”

New Jersey, where Dr. Rosenberg practices, defines the veterinarian-client-patient relationship (VCPR), in part, with the requirement that “the veterinarian has undertaken to make medical judgments regarding the health of an animal” and “the veterinarian has sufficient knowledge of the animal … ”

The statutes in the other 43 states with specific VCPR laws read similarly. Of course, these clauses are open to some degree of interpretation. We ought not debate, however, Dr. Hanes' obligation to meet his state's minimum requirement. In this case, his interpretation included an annual blood test-a component of examining the animal in order to gain sufficient knowledge for making medical judgments about a patient prescribed a controlled drug. The client was aware of this requirement, and she had a variety of options to consider:

• Extended payment options have become more readily available, allowing clients to spread out the cost of annual monitoring.

• The client could have made priority adjustments in her personal budget to allow for the anticipated cost.

• In the moment of crisis, the niece provided financial support. The client could have spoken with her niece prior to the epileptic event.

• Employing any of the above, the client then could have taken advantage of the discount Dr. Hanes offered on the blood test.

• The client could have sought out a different provider who might meet her desires before she ran out of medication.

In the end, she did none of these.

While Dr. Rosenberg suggests that Dr. Hanes could have evaluated previous laboratory results, we suspect that Dr. Rosenberg's own clinical experience might reveal that patients do often show a change in health and laboratory results over time.

Dr. Rosenberg also suggests having the client sign a waiver acknowledging the risks of continued treatment without monitoring. In reality, such waivers do not protect a veterinarian from liability. As the knowledgeable professional, the veterinarian will be held liable if he continually dispenses a controlled drug with known potential adverse effects if those adverse effects emerge and progress in an unmonitored situation.

In Dr. Rosenberg's account, the niece's veterinarian required the same blood test prior to dispensing phenobarbital. Further, Dr. Rosenberg claims Dr. Hanes “lost a good client.” In fact, he lost a client who endangered her dog by refusing an anticipated annual blood test at a discounted rate and whose extended family filed a baseless complaint with the veterinary board.

Finally, Dr. Rosenberg believes Dr. Hanes “exercised poor judgment.” We disagree. Dr. Hanes behaved as we presently behave and will continue to behave. Veterinarians should be neither belittled for upholding practice standards nor ethically or morally chastised for a client's refusal to assume personal responsibility.

Ryan G. Gates, Cuyahoga Falls, Ohio

Annmarie Hill, Aliso Viejo, California

Brenda Mostco, Chagrin Falls, Ohio

Harold Jones, Spring Lake, Florida

Adolf K. Maas, Bothell, Washington

Cindy Ann Shower, Franklin, North Carolina

Danny Skirvin, Surprise, Arizona

Lynda Bacon, Lawrenceville, Georgia

Jeff Garretson, Greenlawn, New York

Elizabeth Noyes, Bluemont, Virginia

Jamie Snow, Mason, Michigan

Jennifer Taylor, Franklin, New Hampshire