Possible Interview Question - would like your opinions!

[rosemma]

I read this interview question online and was wondering what the varying opinions are... I am very interested. Thanks!

A client calls you at 2:00 a.m. with an emergency with his horse. You know this client has not paid his bill for a while. What do you do? Your CPA (certified public accountant) tells you that the practice is hurting financially, now what do you do about this client?

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[critterfixer]

Well, when dealing with a question of veterinary ethics, I think you should look to the AVMA statement of principles and practices. There are several relevant sections in regards to this type of situation:

"PROFESSIONAL BEHAVIOR

Veterinarians should first consider the needs of the patient: to relieve disease, suffering, or disability while minimizing pain or fear.

Once the veterinarians and the client have agreed, and the veterinarians have begun patient care, they may not neglect their patient and must continue to provide professional services related to that injury or illness within the previously agreed limits. As subsequent needs and costs for patient care are identified, the veterinarians and client must confer and reach agreement on the continued care and responsibility for fees. If the informed client declines further care or declines to assume responsibility for the fees, the VCPR may be terminated by either party.

In emergencies, veterinarians have an ethical responsibility to provide essential services for animals when necessary to save life or relieve suffering, subsequent to client agreement. Such emergency care may be limited to euthanasia to relieve suffering, or to stabilization of the patient for transport to another source of animal care.

Regardless of the fees that are charged or received, the quality of service must be maintained at the usual professional standard."

As is the case with ethics, different people may interpret these priniciples in a different manner. My reading of this is that as the horse's regular veterinarian, you would have an ethical obligation to provide emergency services, regardless of the state of the client's account. These services could be limited to stabilization of the horse's condition in order to transfer service to another veterinarian. While you are allowed to terminate the Veterinary-Patient-Client-Relationship (VCPR) for non-payment of fees, the time to do this would have been prior to the client calling you for emergency services, and to refuse to provide care, while the VCPR was still in effect would be unethical.

As I said, others might have a different interpretation, but that's how I'd answer.

 

[banditalfi]

I read this interview question online and was wondering what the varying opinions are... I am very interested. Thanks!

A client calls you at 2:00 a.m. with an emergency with his horse. You know this client has not paid his bill for a while. What do you do? Your CPA (certified public accountant) tells you that the practice is hurting financially, now what do you do about this client?

I work at an emergency practice and in times like these we only provide minimal lifesaving support. I'm not familiar with horse treatments, but if a cat comes in bad shape, generally means fluids for the night until they go to their normal vet, or, depending on how bad the animal is (ie - they wouldn't be able to afford the trip(s) to us and their normal vet) then we euthanize (of course with the owner's consent).

 

[Emio]

i b*tch and moan my way out of bed and drive out to the farm. save a horse's life, tell the guy i need a check by monday, and make it clear he needs another vet, and go back to bed.

 

[chris03333]

In emergencies, veterinarians have an ethical responsibility to provide essential services for animals when necessary to save life or relieve suffering, subsequent to client agreement. Such emergency care may be limited to euthanasia to relieve suffering, or to stabilization of the patient for transport to another source of animal care.

Ethically maybe but legally you are not obligated.

 

[ri23]

My response would be to refer to an ambulatory/emergency service. Veterinary medicine is also a business and you can't stay afloat if you are consistently treating animals and not receiving payment. If it is a true emergency you can go out and stabilize the horse, but it is essential to inform the client that these types of services will not continue in the future.

 

[critterfixer]

Ethically maybe but legally you are not obligated.

I think the legal ramifications of refusing to provide emergency treatment when there is an already established VCPR vary depending on location. My own state, Tennessee, does not seem to require it, but a small sampling of a few who do follows:

Louisiana's Veterinary Practice Act states:
With regards to emergency care, please refer to the Practice Act's Section 1518A(9) granting the Board the power to adopt rules of conduct, and Section 1526A(14) regarding unprofessional conduct. Board Rule 1001A does, in fact, adopt the AVMA's Code of Ethics. Principle II.F of the Code of Ethics states, in pertinent part, that "in emergencies, veterinarians have an ethical responsibility to provide essential services for animals when it is necessary to save life or relieve suffering."

The Board interprets this responsibility, in general, to mean that the veterinarian must stabilize a true emergency condition regardless of whether it is an established patient or not. Such must be done without concern for compensation. In the event services are then needed beyond the stabilization, the veterinarian may demand payment (or arrangement for payment) for further services prior to provision of such services.

From the New Jersey State Board of Medical Examiners:

All licensed veterinarians must provide emergency
care.

Georgia:

700-12-.06 Emergency Coverage.
(1) A licensed veterinarian employed at a veterinary facility must ensure that emergency treatment or access to emergency treatment to clients with an established veterinary-client-patient relationship is provided.

So while it's true that the AVMA's Principles and Practices are ethical guidelines and not laws, some states have, in fact, adopted these guidelines in their State Practice Acts, which does then carry legal ramifications for failing to act ethically.

As to the OP, I think the question is designed to determine whether or not you are familiar with the AVMA's guidelines.

 

[chris03333]

I think the legal ramifications of refusing to provide emergency treatment when there is an already established VCPR vary depending on location. My own state, Tennessee, does not seem to require it, but a small sampling of a few who do follows:

Louisiana's Veterinary Practice Act states:
With regards to emergency care, please refer to the Practice Act's Section 1518A(9) granting the Board the power to adopt rules of conduct, and Section 1526A(14) regarding unprofessional conduct. Board Rule 1001A does, in fact, adopt the AVMA's Code of Ethics. Principle II.F of the Code of Ethics states, in pertinent part, that "in emergencies, veterinarians have an ethical responsibility to provide essential services for animals when it is necessary to save life or relieve suffering."

The Board interprets this responsibility, in general, to mean that the veterinarian must stabilize a true emergency condition regardless of whether it is an established patient or not. Such must be done without concern for compensation. In the event services are then needed beyond the stabilization, the veterinarian may demand payment (or arrangement for payment) for further services prior to provision of such services.

From the New Jersey State Board of Medical Examiners:

All licensed veterinarians must provide emergency
care.

Georgia:

700-12-.06 Emergency Coverage.
(1) A licensed veterinarian employed at a veterinary facility must ensure that emergency treatment or access to emergency treatment to clients with an established veterinary-client-patient relationship is provided.

So while it's true that the AVMA's Principles and Practices are ethical guidelines and not laws, some states have, in fact, adopted these guidelines in their State Practice Acts, which does then carry legal ramifications for failing to act ethically.

As to the OP, I think the question is designed to determine whether or not you are familiar with the AVMA's guidelines.

These laws are in effect during you business hours. A client can not make you go out on off hours (what if your on vacation in another country???). Your only legal duty is to refer to an emergency clinician.

 

[critterfixer]

These laws are in effect during you business hours. A client can not make you go out on off hours (what if your on vacation in another country???). Your only legal duty is to refer to an emergency clinician.

Laws are like ethics, and subject to interpretation. I don't interpret it the same way you do. I am likely influenced by our Dean's interpretation, and he said very clearly that if you have an established VCPR, that you cannot NOT treat the animal, unless you have made arrangements for a specific veterinary practice to cover for you in your absence, or you have fired the client. In the situation presented by the OP, it doesn't sound as though the client had been fired, nor did it say the client was directed to use an emergency service. I am making the assumption the veterinarian was being called in the middle of the night because that is the number the client has to call for emergencies, thus the veterinarian in that case is used to working his own emergencies. Wouldn't that qualify as business hours?

 

[shuvball1]

Critterfixer:
I'm not too aquainted with LA services, so are there very many LA emergency services? I was under the assumption that a LA vet was typically the sole provider of veterinary care to their patients, providing both regular and emergency services. If this is the case, it seems the vet would be obligated to at least stabilize, if not treat, the animal.

 

[Kara31191]

HAHA. My vet says "I don't have any staff", and emails a list of emergency vets. ((If it's a REALLY GOOD CLIENT or a staff member she would help us))

 

[VAgirl]

Critterfixer:
I'm not too aquainted with LA services, so are there very many LA emergency services? I was under the assumption that a LA vet was typically the sole provider of veterinary care to their patients, providing both regular and emergency services. If this is the case, it seems the vet would be obligated to at least stabilize, if not treat, the animal.

A LA vet that I've shadowed always has one of the vets in the practice (5 of them) on call. But there is still an emergency hospital in the city (or a short distance away). So they'll respond to non-office hours emergencies. But there are some instances in which they won't go out (according to one of the vets). These include extremely bad weather, if the client is calling for advice on getting the animal through the night and doesn't necessarily think the vet needs to come out, or if the person is not already a client (especially if they seem a bit off...). I don't think their policies on this would change, even if the 24-hour emergency facility didn't exist in the nearby area. But I guess if you can solve a LA situation without the need to transport, that's better?