Shades of gray in the veterinarian-client relationship

Dr. Lee Hanes practiced with two partners at Mountain Animal Hospital. After 11 years, the practice had grown significantly. One of the reasons for this success was the clinic's ability to cater to the needs of its upscale clientele.

Dr. Hanes would be the first one to admit that the practice pampered its clients. It wasn't unusual for valued pet owners to have doctors' cell phone numbers. Nor was it unexpected for clients to meet a veterinarian after hours at the hospital for care. While this might sound like veterinary practice from decades past, it proved to be a winning formula for Dr. Hanes and his group.

Photo source: Getty ImagesRecently, the staff had noticed that clients were starting to disregard prescription renewal protocols. Pets on NSAIDs and other long-term medications were supposed to undergo periodic blood testing before their prescriptions were renewed. The staff began to tactfully inform clients that these blood tests had to be done before medications would be refilled. Not monitoring a drug's impact could solve one problem in the pet but create another, they told the pet owners who called.

Mrs. Longman had been giving her dog Cuddles phenobarbital for his epilepsy for five years. She was retired, and she and Cuddles were living on her social security benefits. Cuddles' last three blood profiles had showed her liver values to be within normal range and her phenobarbital level to be in the therapeutic range. Mrs. Longman had no problem affording the inexpensive prescription phenobarbital, but the yearly blood test was a financial hardship. She believed that with her limited budget she be allowed to refill the dog's medication without the testing.

Dr. Hanes respectively disagreed. He believed he would be professionally negligent if he continued to prescribe a controlled substance that had the potential to harm a patient more than it helped. He offered Mrs. Longman a discount on the testing, but it was still beyond her budget. Dr. Hanes reluctantly told Mrs. Longman that his hands were tied-monitoring the status of a patient taking a controlled barbiturate was standard veterinary practice.

Within a week of going off her medication, Cuddles experienced a grand mal seizure, fell on the stairs and injured her knee. Mrs. Longman's niece intervened and took Cuddles to her personal veterinarian. The niece paid for the blood test and Cuddles' phenobarbital prescription was renewed.

Mrs. Longman's niece was disturbed by her elderly aunt's experience and filed a complaint of professional misconduct against Dr. Hanes on behalf of her aunt and Cuddles.

The state veterinary board believed that this was an unfortunate experience but that Dr. Hanes had acted both professionally and within the normal standard of care. The pet owner's financial status was not grounds for a veterinarian to take medical shortcuts that could endanger the health of the patient.

Mrs. Longman greatly appreciated her niece's help, and Mountain Animal Hospital lost a good client. The experience prompted Dr. Hanes to take a long, hard look at his clinic's policy on mandatory blood screenings for chronically medicated pets.

Rosenberg's response

If you learn just one thing after years of veterinary practice, it's that most situations are not black and white. Hard-and-fast rules don't work when your patients and clients are dynamic individuals. Dr. Hanes was not guilty of unprofessional conduct-he just exercised poor judgment.

He could have asked Mrs. Longman to sign a waiver acknowledging the risks of not monitoring her epileptic dog's blood parameters and then dispensed the medication. He could have made the blood testing affordable for this needy client as a humane gesture. He should have seen that Cuddles didn't have elevated blood values in multiple previous test results and made a calculated exception. In the end, he did none of these.

My message to Dr. Hanes? Live and learn.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. The veterinary practices, doctors and employees described in “The Dilemma” are fictional.