Real world implications
What a cornucopia of practice management issues, legal questions and ethical considerations this little tale presents. And
how commonly veterinarians and their clients face this dilemma out there in the general pet owner universe.
As I mentioned, one of my associates was in a similar position just a few weeks ago. A dog presented with an open pyometra
and the client refused immediate ovariohysterectomy. Our client's reasoning was simpler, however; she couldn't afford a routine
spay, let alone an emergency pyometra procedure, until she sorted out her finances.
First, let's consider the two dogs' level of suffering. Both patients had wagging tails, showed good appetite and were bouncing
off the walls, yet they were harboring a diseased uterus and exhibiting a substantial purulent discharge. Suffering? They
were probably just uncomfortable.
The emergency doctor in the first account appears to have provided her client with only two treatment options: spay immediately
or euthanize immediately. I'll leave it to you to decide whether an offer of a short period of "wait-and-see," together with
antimicrobial and other nonsurgical therapies, would result in so much pain and risk to the dog that a legal threat aimed
at the owner was preferable.
Second, was a threat really the best way to handle this matter? Maybe I could more comfortably accept that strategy if the
patient had a "closed" pyo, was febrile or PU/PD, or at least was presenting some clear indication that a short period of
medical management and observation would be detrimental.
When my associate was faced with her pyometra case, she advised the client that the need for a spaying procedure was very
likely. But she added that instituting medical therapy and allowing a brief delay so the client could get her financial situation
in order was not an unreasonable alternative.
I think my practice did a good job of keeping the lines of communication open with this client. If my associate had badgered
the woman into either euthanizing her dog or grudgingly accepting the spay procedure under threat of legal consequences, all
the outcomes would probably have been negative.
Chances are, the client would have never returned. She would have shared her horrible experience with anyone who would listen.
Worse yet, she might have contacted the state board to report that she'd been coerced—not only into following one practitioner's
advice, but into purchasing the recommended services from that one specific provider.
Legal, ethical considerations
Did the emergency veterinarian have the legal authority to insist that the pet owner concede to her recommended treatment?
Was she legally entitled to demand that the procedure be performed by a certain deadline? Would she have been justified in
making the threat if the owner had wanted to wait and have his own veterinarian do the spay the next day? What if the owner
had said he wanted a second opinion at a competing emergency practice?
Finally, where would the emergency clinic or the emergency doctor be legally if the client had elected euthanasia instead
of spay? Obviously there was no way to prove that this open pyometra would not eventually prove fatal if left untreated surgically.
Nonetheless, if the client had elected euthanasia instead of spay in the face of a threat of being reported to authorities,
would the emergency hospital and its employed doctor be vulnerable to a lawsuit? The pet owner would only have to Google "open
pyometra" to discover that this condition sometimes resolves without emergency ovariohysterectomy.
One last thought: Would it have been a cataclysm if the emergency veterinarian had repressed the urge to threaten and followed
up with a call the next morning to make sure the client was acting responsibly and following through with the matter at his
regular veterinarian's office? If the ER veterinarian couldn't confirm that the dog was being cared for, okay, fine—maybe
a call to the ASPCA authorities might be an appropriate next move.
As it is worked out, both pyometra dogs are now thriving. My associate's patient was spayed during regular business hours
a couple of days after diagnosis, and the other practitioner's patient is proudly producing show pups.
Our client is a happy camper. I wonder how client retention stats are looking at the emergency clinic.
Dr. Christopher Allen is president of Associates in Veterinary Law PC, which provides legal and consulting services to veterinarians.
Call (607) 754-1510 or e-mail