Last week my office received a fascinating e-mail containing an account from a veterinary practitioner who is deeply involved with the ever-changing landscape of veterinary law. The story, which involved one of his clinic's show dog patients, stirred up a lively debate in the veterinary law cybersphere. I certainly found it compelling, especially since a very similar set of circumstances had unfolded at one of my own practices the previous month.
The emergency veterinarian evaluated the dog and confirmed the pyometra. She then recommended that an immediate ovariohysterectomy be performed. The owner refused, citing his desire to obtain future litters from this dog, and did his best to fully explain his wishes to the doctor.
The emergency doctor replied that if the owner did not allow her to spay the patient by 5 p.m. that evening, she would report him to the authorities for animal abuse. The owner left with his dog and obtained medical therapy for her elsewhere. The patient recovered fully and a fresh litter was produced during her next cycle.
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