Saturday, February 28, 2009

Emergency Redux

On December 13, 2008 I posted about the Emergency Clinic experiences of three different pet owners. Of the three, only the cat owner had what seemed like a really good outcome. At least her cat was still alive which was more than could be said of two dogs and one puppy belonging to the other two pet owners. Sadly, more has come to light about the cat owner's experience and I can't decide if I'm sickened or just furious. Here's what transpired. There will be no names mentioned, nor will I say where it occurred. It could happen anywhere, to any pet owner.

The pet owner in question is a medical professional so she's not an uninformed individual. She also adores her cats and dogs and has done a good deal of rescue work. Her health, of late, has not been what it should have been which has meant that she could only drive when she felt she could do so safely. (A recent surgery should have resolved that issue.) She had brought the cat to the Emergency Hospital as reported earlier, where it was discovered that he had ingested a piece of jewelry dropped by a neighbor's child, that had cut him up internally. You already know that he survived that episode but here's the short version of what I have discovered since then.

Complete bloodwork was done, hence, it should have been analyzed. He also had an upper respiratory problem. They would only look at one thing even though she had his care transferred to a specialist who specialized in respiratory issues. Not only did that specialist not check for that issue but the owner was told she'd have to make a separate appointment with the specialist at her practice for that. Nor did the specialist at any time talk with the owner on the phone. Further, they did not do a complete enough workup, despite having complete bloodwork, to tell her if there were something else going on besides the issue with the swallowed item.

Not being able to travel to the hospital each day, but calling many times around the clock, the hospital staff implied that she was a bad owner for not being at the hospital! Nothing could be further from the truth. She desperately wanted to be there but couldn't drive and there was no one to take her there. A friend who is an experienced cat owner and also has health problems, said she'd go visit the cat in the hospital. The owner made arrangements, calling to give permission. When the woman traveled all the way across town to the hospital, they refused her admittance to see the cat. The owner had never denied any tests or treatment, despite the cost. She was well aware of the fact that Emergency hospitals are expensive. She wanted the best care for her cat. And they would not allow a friend to visit in her stead to reassure her that she had seen the cat and spent some quality time with him.

You may be thinking that all of these things are trivial since the cat survived but there's more. The records were to be sent to her regular veterinarian so that he could follow up and would have the bloodwork. When the cat got sick again, becoming quite lethargic, she discovered that the records had never been sent to her veterinarian from the Emergency hospital. He had no opportunity to see the results of the lab work.

She took the cat to another specialty hospital to see a well-respected respiratory specialist along with another of her cats who was displaying respiratory symptoms. The older cat's problem is the result of something structural but she's essentially fine.
She thought the younger cat's problem was his respiratory issue which seemed to be worse and wasn't responding to antibiotics

More bloodwork was done on the young cat at the referral hospital. The little guy had to stay to be rehydrated and he needed more tests to try to determine what was at the root of his problem. The resulting bloodwork showed that the young cat was in kidney failure! That should have been discovered at the Emergency hospital, had they properly interpreted the bloodwork. If they had sent the records to her regular veterinarian, he could have discovered the kidney problem and the little guy could have been started on subcutaneous fluids immediately at home to prevent exactly the dehydration and lethargy that resulted from lack of diagnosis.

Frankly, I call this bad medicine. I believe that it is important for veterinarians to look at the entire animal. Yes, treat the emergency for which he was admitted but if the bloodwork tells you that something else is going on, then tell the client that there's another problem as well. First Do No Harm. And why didn't they follow through by sending the records to the client's veterinarian? Why did they repeatedly infer that the owner is a bad owner? Why did they refuse to allow the owner's friend to see the cat when the owner had called specifically to give permission?

That hospital saved the cat from one problem but allowed his kidney problem to go undiagnosed when they had all of the information in their hands and added further to their mistake by not sending a copy of the records to the client's veterinarian. They allowed the cat to suffer because they missed the diagnosis or didn't care enough to properly interpret the bloodwork.

How many other Emergency Hospitals function this way? How many clients are mistreated? How many diagnoses are missed when the information is in the bloodwork results that are right in front of them? This could have happened anywhere. To anyone. This isn't a story. This is real. It happened.

My heart aches for this owner, this cat, and for all of those others who may have suffered from a similar experience.

By and large, veterinarians are excellent practitioners. Be sure you have fully investigated all Emergency options before you need emergency care. Ask questions. If the State Board keeps records of formal complaints, ask if there are any against that hospital or any specific veterinarians who practice there. Sadly, too few people report these issues. Caveat emptor: let the buyer beware.

Yes, the one "good" Emergency hospital in my previous blog post wasn't so "good" after all.


Karina A. said...

Like you very appropriately say in your post, pet parents need to ask question. It's always up to us to follow up and investigate prior to selecting a health guardian for our four-legged pals. Thanks for sharing this with us as I'll do the same with my friends!

Darlene said...

Unfortunately, Karina, in this case, that Emergency hospital was the only one in her area. But for anyone who has choices, I strongly urge them to investigate before there is an actual emergency. She had found the one and only Emergency hospital. Fortunately, another has now opened in that area so she will never have to deal with that first one again.

Barbara Ruth Saunders said...

I recommend the book "Vet Confidential" by Dr. Louise Murray. She is director of medicine at the ASPCA. The book helps veterinary consumers become more informed about their choices, choose the best possible medical practices, and demand the best. Full disclosure: Louise and I went to high school together.