Surgery bill surprise

Dr. James Hanks is a boarded veterinary surgeon who worked as a staff surgeon for 11 years at the state veterinary school. Several years ago he opened a mobile surgery practice. He lives in an upscale suburban community and offers his services to the 12 small animal practices in the surrounding counties.

When a local general practice clinician makes a challenging surgical diagnosis, Dr. Hanks comes to his or her veterinary hospital and performs the procedure. Technology allows him to review lab work and radiographs remotely when preparing for a surgery. He charges the clinician a flat fee for his services and the referring veterinarian marks up the procedure total to cover the hospital fees. Dr. Hanks has an excellent reputation and working relationship with the referring veterinarians in his area. With this system, local clinicians can offer the services of a university-trained, board-certified veterinary surgeon to their clients.

One day, Dr. Hanks receives a call from Dr. Lu concerning a 7-year-old Rottweiler named Chunk. Urinary abnormalities have prompted Dr. Lu’s team to perform a complete diagnostic workup, including abdominal radiographs, which show a large, softball-sized mass in the area of the left kidney. Dr. Lu has determined that the mass should be removed and biopsied; he asks Dr. Hanks to perform the procedure on Chunk.

Dr. Hanks arrives at the hospital at 9 a.m. on the day of the surgery and reviews all of the presurgical blood work and anesthetic protocols. He has worked at this facility in the past and is very familiar with the support staff. He sets out to work.

The surgery reveals a large mass involving the kidney. Dr. Hanks removes the kidney uneventfully and remains at the facility for an hour and a half after the surgery to make his notes and observe the patient’s recovery. He then leaves the clinic to travel 23 miles to his next surgical appointment.

At 4 p.m., Dr. Lu notices that Chunk is slow to rise and is more depressed than he should be five hours after surgery. He evaluates the dog and determines there is some internal bleeding. He calls Dr. Hanks, who volunteers to return to repair the problem, but Dr. Lu has already arranged for the dog to be taken to the nearby 24-hour emergency hospital. Dr. Lu closes his practice at 5 p.m. and does not have overnight staff on duty.

The veterinary team at the emergency clinic determines that the dog is experiencing bleeding due to a slipped ligature. The doctor on staff performs surgery, the bleeding stops and the dog is fine. This is a happy ending for Chunk—but not for Chunk’s owner. The surgery at the emergency clinic costs $1,150, on top of the $3,200 Drs. Hanks and Lu have charged.

The client wants Dr. Hanks to pay the emergency hospital fee. He believes it’s the surgeon’s obligation to tend to the patient’s needs until the surgery is completely resolved, and this obligation should encompass both surgical and financial responsibility. Dr. Hanks does not agree. He performed the surgery competently. Prior to surgery, the owner was made aware of the potential for complications and signed a surgical release to this effect. Dr. Hanks had even offered to return to the clinic to resolve the complication when it arose. Instead, emergency care was provided and the patient was properly cared for.

Dr. Hanks maintains that he has done everything ethically required of him as Chunk’s veterinary surgeon and feels bad that further cost was incurred; nevertheless, he is not responsible for compensating the owner for additional surgical fees. The pet owner disagrees but pays all outstanding balances and informs Dr. Lu that Chunk will not be returning to the practice for any type of care in the future.

Rosenberg’s response

Technically, Dr. Hanks has met all of his obligations in caring for this pet. Unfortunately, Dr. Lu, the referring veterinarian, is the one who has suffered the loss of a client.

Some veterinarians think assisting a client with payment in this type of case is an admission of wrongdoing, but that’s not true. There are creative ways of helping the client when legitimate and costly complications arise. Veterinarians must always remember that we are healthcare hybrids—medical care professionals and small-business owners. How do we keep the pet owner satisfied when complications arise?

In this case, Dr. Lu could have issued a future hospital courtesy credit for the pet owner’s stress during this difficult procedure. This way, everyone wins. The owner gets a monetary benefit, and Dr. Lu retains a client who must continue to use his services to take advantage of the courtesy credit.

There are ways to maintain professional standards while at the same time being a successful business owner. There is no right or wrong in this situation. Compromise serves everyone’s needs and all concerned are somewhat satisfied. Often, that is the best possible outcome.

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