Advice On Complaining About Vet Service/treatment

[NeylasMom]

I am unhappy with the care that Violet received at the first hospital I took her too when she was suffering from rhabdomyolysis. Some of the details are in my other thread, but the long and short of it is that we spent 2 hours there without her receiving any treatment (aside from sub-Q fluids that were given 1 1/2 hrs into our visit when I finally said, screw this waiting around, give her fluids!) before they realized it was heat related like I had told them from the start and sent us off to an emergency facility. More importantly, I fully believe that if I hadn't pushed and pushed the vet on how we could (or could not) rule out a heat related episode he would have sent us home and told me to "keep an eye on her".

 

I placed a call today and am waiting to hear back from the hospital administrator, who, it turns out, was the person who I thought was just an experienced vet tech who was working with the vet on Violet's case that day. I'm a little unhappy that the person "in charge" is one of the people that was treating us, but the options I was given were to talk to her or the vet.

 

Any suggestions on how to deal with this? Or experiences from people who have? I'd especially like to hear from people in the vet profession. I don't want to be over the top here, I realize that encountering rhabdo is probably relatively unusual, but we definitely did not receive the best care we could have. Obviously my first step is just to talk to them and see what they say and then go from there. I'm surprisingly nervous, probably because I'm still upset about the whole thing and I guess I just want to make sure I'm not overreacting. I can give more details on what I felt went wrong if needed.

 

Original thread

[Guest Katherineaz]

In July I lost my handsome (young) Cavalier Avery. I had taken him to the vet (30 minutes before closing), who ran no test and told me to feed him rice and chicken for a couple of days (he was throwing up and had a very odd diarrhea - even right there in the office the whole time). That evening I woke to him passed out next to me in a pool of blood, I lost him the next day (took him to the ER Vet that time). I blame myself everyday for his death.

 

I have yet to speak to the vet's office, as I am still so angry. Would they even care? I would be interested in knowing too how something like this should be handled.

[macoduck]

Have you written all your thoughts down, point by point? Tell them that you will send/mail/email them a copy so they can review what happened at their facility and the correct lifesaving steps taken at the other facility.

 

What do you ultimately want? Money or an apology or both? At the least, you don't want any other dogs to suffer what your girl did.

 

It will be interesting to see how they react.

[Guest Yankeegreyhound]

I think what a PP said is important - what do you want to gain by talking to them?

 

I've run into a bunch of awful doctors. From my son's pediatrician to Sara's first vet in NY. For my sons doctor, I just expressed my feelings and let it be known that I will not be coming back and I will not recommend them to others.

 

For Sara's vet, I never said anything. I just never went back. She told me she was a greyhound savvy vet. She was great with my cat and fine when I brought the dogs for check ups but thank goodness i didn't rely on her for a greyhound emergency. Long story short - The tumor in Sara's leg was getting larger and larger. We had a biopsy done and it came back benign but the spot where the biopsy was done wasn't healing and the tumor was growing by leaps and bounds. She gave me 2 options. 1. debulking the tumor - she didn't have a positive outcome with this and thought it was just a temporary fix 2. - putting her to sleep. She said "greyhounds don't do well with amputation". Thank goodness I knew better and we ran out of there. I never went back and never told them why. I just make sure I tell anyone who has a greyhound in our area and asks about a vet, about our experience there.

[NeylasMom]

In July I lost my handsome (young) Cavalier Avery. I had taken him to the vet (30 minutes before closing), who ran no test and told me to feed him rice and chicken for a couple of days (he was throwing up and had a very odd diarrhea - even right there in the office the whole time). That evening I woke to him passed out next to me in a pool of blood, I lost him the next day (took him to the ER Vet that time). I blame myself everyday for his death.

 

I have yet to speak to the vet's office, as I am still so angry. Would they even care? I would be interested in knowing too how something like this should be handled.

I'm so sorry this happened to you. I know you are still processing your grief, but if it were me, I would absolutely follow up with the hospital and possibly file a complaint against the vet depending. Whether they will care and try to make amends or try to cover their butts is another question, but it shouldn't stop you from trying. I have the benefit at least that Violet is okay, things would be very different if she weren't.

 

Have you written all your thoughts down, point by point? Tell them that you will send/mail/email them a copy so they can review what happened at their facility and the correct lifesaving steps taken at the other facility.

 

What do you ultimately want? Money or an apology or both? At the least, you don't want any other dogs to suffer what your girl did.

 

It will be interesting to see how they react.

Thanks, these are good things to think over. She actually called me back more quickly than I expected so I've already talked to her. She was very receptive and in no way defensive. She had been receiving the records from the emergency facility and had already done a little follow-up, but she is going to talk with the vet again, as well as the medical director now that she has my feedback and have the medical coordinator call me back. I think I will take your suggestion and write down what we discussed and send it so she can refer to it when she speaks with the medical coordinator.

 

She did admit (again) that the vet we saw is new and while a supposedly very good vet, needs work on his communication and assertiveness as she put it. I think he also needs work on his critical thinking/diagnostics and said as much, but it's difficult because they were almost never in the room with me together so she's hearing what I think happened and what he thinks happened and having to try to reconcile the two.

 

My two main issues were:

1) Why wasn't the urine sample taken and spun down to look for myoglobin much sooner? Why did I have to push and push the vet until he thought of it? I didn't really get a satisfactory answer on that one, except that that vets are trained to look for the horses and not the zebra and I had a zebra (in other words, diagnostically they'd be looking at the more likely choices rather than the less likely one even though that's what was going on and that's what I was telling them was going on). I have to mull this over and I would love some feedback from vets and techs here on whether you agree with it.

2) The IV fluids weren't started immediately. I demanded them from the tech (not the experienced one, a different one) along with the blood work and u/a (which they cannot run in house) the minute we walked in the door, but she said I needed to wait for the vet and he would be able to start them. Then the vet steered me toward these other things and I, thinking we weren't all that worried about heat stuff anymore said okay, let's see what the tests say and then decide. It sounds now like the vet didn't necessarily agree with that, but he didn't communicate that to me. The tech says that knowing he was new and being more experienced (she's been in the business 30 yrs) now feels she should have been "pushier" with me and said, you wanted the fluids, the vet wanted the fluids, why aren't we starting the fluids?

 

Honestly, if she had done that (or if he had, since it was really his responsiblity as the vet to advocate for my dog) then we wouldn't be here. It wouldn't have mattered that the test for myoglobin didn't happen until later on because she would have essentially been receiving the treatment she needed while we continued to investigate. Since that seems to have been a direct lack of his ability to be assertive and they're acknowledging that and being open to my feedback, I think I will just see how things go. I had considered asking for some of my money back or filing a complaint. I definitely will not do the latter, pretty certain I won't do the former either. My main concern is just that this doesn't happen to someone else moving forward so I guess the big question is they seem to recognize the problem and want to address it, but how will they ensure that happens? Or I may just have to be content with the fact that have acknowledged that they will.

Edited September 24, 2013 by NeylasMom

[greysmom]

I'm unclear what the vet should have been more proactive/assertive about?? Did the techs not begin a treatment that he had ordered? Did the techs ignore him? Or did he ignore your questions and suggestions? I also don't understand how the vet is supposed to be your dog's advocate. With who? And - respectfully - that should be the owner's job, not the vet's. The vet's job is to analyze the condition of the animal presented, based on his knowledge and experience. And an e-vet needs to be more like an ER trauma doctor rather than a "regular" vet - more used to thinking out of the box, analyzing quickly and thoroughly, and beginning treatments as soon as possible. The fact that this one didn't even begin basic trauma treatment (fluids), and didn't order basic tests, is strange and unnerving. I don't think I've ever been to the e-vet with a dog that they didn't immediately begin IV fluids for whatever was the problem!

 

FWIW, I think you did the right thing by taking Violet away and to another hospital. You shouldn't have had to. I'm glad the administrator has been responsive to your issues and is following up.

[Hubcitypam]

I you are really mad you can always go to the state Vet Board. Maryland has a complaint form.

Edited September 24, 2013 by Hubcitypam

[cmc333]

Jen - the way I would have handled it is NOT the way anyone normal would handle a situation like that. I've had experience with a vet who I swear bought his degree online. Since I was the one paying the bill, when he didn't want to do certain tests that day (in a quasi-emergency situation), I just flat out told him "I'm paying the bills here and if this is something I want done, just DO it." If that is what it takes, so be it. Depending on the situation, I might or might not apologize at the end for losing my temper.

 

I would never ever in a million years talk to my personal doctor that way, but the dogs only have me to speak for them. I don't care if I piss off a vet; I can always find another - good one - again.

 

Now you can see why I wouldn't recommend my handling of the situation. I do have a horrendous temper and I wil fight to the death for my dogs; if I think or gut-feel the vet is wrong then I speak up - loud and clear!

 

I've only had one bad experience with one vet like that; my current vet I just love.

[a_daerr]

My vets always err on the side of what could potentially be the most serious possibility. I always thought that was standard procedure- sort of like a CYA thing. Anytime I've called with a problem, even if it's a seemingly minor problem, their response is either (1) Bring your pet in ASAP, or (2) Take him to an e-vet ASAP. I'd hate to see what other kinds of mistakes these people have made with such a laissez faire "wait and see" attitude. Just my two cents.

[Burpdog]

I would make sure the vet knows this was a life and death situation and that your dog could have easily died. This is not a screw up to be taken lightly.

[NeylasMom]

I'm unclear what the vet should have been more proactive/assertive about?? Did the techs not begin a treatment that he had ordered? Did the techs ignore him? Or did he ignore your questions and suggestions? I also don't understand how the vet is supposed to be your dog's advocate. With who? And - respectfully - that should be the owner's job, not the vet's. The vet's job is to analyze the condition of the animal presented, based on his knowledge and experience. And an e-vet needs to be more like an ER trauma doctor rather than a "regular" vet - more used to thinking out of the box, analyzing quickly and thoroughly, and beginning treatments as soon as possible. The fact that this one didn't even begin basic trauma treatment (fluids), and didn't order basic tests, is strange and unnerving. I don't think I've ever been to the e-vet with a dog that they didn't immediately begin IV fluids for whatever was the problem!

 

FWIW, I think you did the right thing by taking Violet away and to another hospital. You shouldn't have had to. I'm glad the administrator has been responsive to your issues and is following up.

This wasn't an e-vet, it was a VCA hospital that happened to be the nearest facility to where we were that was also open (we got there at 1:30 and they are open until 3, which is the reason why, when I finally said to give the fluids, it was sub-Q and not IV, because they were closing and there wasn't "enough time" to do IV).

 

I believe the vet should have been more proactive about how to diagnose or rule out something heat related since when I walked in the door, that was what I told them was what I felt was going on and I gave specific reasons why. But because they didn't see a dog in "crisis" they didn't immediately give treatment and started discussing all of these other possibilities and diagnostic tests they could run in addition to the blood work (they could run a basic panel and did) and urinalysis (they cannot run in house) that I requested. Everything is in my other thread, but UTI, stones, and a tumor were on the list and the diagnostics he was talking about were x-rays and an ultrasound; he never brought up spinning down the urine to check for myoglobin until much later when I pointedly questioned him on whether he was certain it wasn't heat related and when he said no, how we might possibly rule it out.

 

What I meant about him being the dog's advocate is that he is the one who needs to be able to do the differential diagnosis and present me with all of my options for testing, and that he had a responsibility to tell me if he felt the dog should receive a specific treatment or diagnostic test immediately. Ultimately I am my dog's best advocate and I absolutely know that, but I am not a vet. I rely on the vet to give me input to make decisions and I should be able to trust that if he thinks my dog needs a certain treatment, he will tell me.

 

Here's the brief timeline, maybe this will help:

-I call them to tell them I'm on my way and I believe my dog is having a heat related episode (I'm about 10 min away at this point)

-They are waiting for me when I get there (@1:30) and a tech weighs her and takes her temp (normal) immediately. I tell them I want IV fluids started immediately and blood work and a U/A done. Tech tells me I need to have the consult with the vet and then he will order those things

-Vet comes into room, I tell him what's happened, tell him what I want, he tells me he doesn't know if they can do those things in house and has to go check. I feel no sense of urgency now or at any point from him.

-Comes back and tells me they can do a basic blood panel, but have to send out for a full cbc and cannot do a u/a in house, they have to send that out

-They pull blood to run the basic panel at my request and we discuss what could possibly be going on. At this point, I believe he is steering me away from a heat related issue so I tell him we can see what blood work says before starting fluids. He raises NO concerns about this.

-In the meantime, I take Violet out to get a urine sample and am mulling all of this over. I realize that I'm not trusting my gut and come back in with teh urine and tell the tech I don't want to wait, I want the IV fluids started right away

-The vet comes in after seeing the blood and tells me the tech will be in to give fluids momentarily. At this point, his demeanor has changed a little because he's seen the urine and realizes (as I told him) that it's not just a little blood in her urine, that her urine is dark red. He tells me a UTI would be unlikely to cause that much blood, it's more likely a stone has caused a cut that is bleeding or possibly that a tumor has ruptured. I ask him if he is CERTAIN it's not heat related at this point? He says no. I ask him if there is anything else we can do to figure that out. He thinks, then tells me he could spin down the urine to check whether it's blood or myoglobin. I tell him to do that immediately. ***This is a key point - I fully believe that had I not pressed him on what else we might do to rule out a heat issue he would not have come up with this on his own and would have just sent us home***

-While he's off getting that sorted out (it's near closing time now) the tech comes in and tells me they have to do subQ fluids because there's no time left for IV so that's what we do. At this point, the tech is reiterating the belief that it's probably stones and that an x-ray would be the next diagnostic step. She leaves. We've now been there an hour and a half (it's 3 pm). I am waiting for them to spin down the urine and I am still waiting for any blood test results (maybe it was just my panic, but I felt at every step there were long delays while he went to "check" on things or run tests - I did have time to make phone calls and chat with the friend who had been with me on the hike via gchat at various points so I know there were delays). While I wait, I post this to GT (all of the possible diagnostics in the last paragraph are what he's suggesting - you can see his intent at that time was to send us on our way):

 

Went to closest vet we could find, they've given her subq fluids, 500 ml (theyre closing, no time for IV) and we're waiting for a basic blood chem. they can't do UA in house so are spinning it down to see if its all fresh blood that separates out to try to rule out heat issue. They're also doing something to look at hematocrit and blood and bloody urine will get sent out for full CBC and UA...

...Heat not ruled out but they seem less inclined to think its that. Both the new rather clueless vet and the amazing vet tech of 30 years think its most likely a stone, but UTI isn't completely off table (they think its too much blood for that) and bladder cancer or a benign tumor rupturing have also been brought up.

 

Thoughts? Depending on blood, we will prob do X-rays to look for stones. Anything else? I can get am ultrasound but we will have to go to the emergency clinic closer to my house. Same if i wamt to do IV fluids or she needs a blood transfusion because they close at 3.

 

-Vet comes back (it's almost 3:30 now) with a tube of urine that is cloudy and red. He tells me it's myoglobin and hands me the sheet of paper with the nearest e-vet facilities. I start to panic again, hastily pay my bill and rush out and get her to the facility where she spent the 2 days.

Edited September 24, 2013 by NeylasMom

[claudiav]

sorry, I never heard of this.... i don't mean to highjack this thread... what is spinning the urine? what is myoglobin and why did they sent you to the e-vet as a result?

[NeylasMom]

sorry, I never heard of this.... i don't mean to highjack this thread... what is spinning the urine? what is myoglobin and why did they sent you to the e-vet as a result?

Click on the link at the bottom of my first post if you want the whole story. If you spin urine (presumably in a cetrifuge ) with blood in it down, the red blood cells will separate out and pack at the bottom. The fact that that didn't happen with Violet's urine told us that it wasn't blood in her urine, but myoglobin, which is a byproduct of the muscle breaking down when rhabdomyolysis occurs.

Edited September 24, 2013 by NeylasMom

[Guest MnMDogs]

First off, how terribly scary to read this all over again...

 

I think if your main goal is to make sure this doesn't happen again, and it seems that the vet facility wants the same thing, then you do what we do in clinical research. Put a CAPA together. Identity the root cause of this failure, and list steps to address that failure and put in place steps to ensure it doesn't happen again.

 

Very glad it turned out well for you and your girl in the end.

 

ETA- what really scares me about this, is if this were another dog with another owner (me for example), I would not have pushed this, and the outcome could have been very different. I know vets can't know everything, and they're human, but they really do need to look at why this happened, and make sure it doesn't happen again.

Edited September 24, 2013 by MnMDogs

[cleptogrey]

good luck dealing w/ a vca hospital. it's a mega big coorporation who has bought up just about everything around. if anyone can beat that giant down w/ reason and persisitance it's YOU!

[krissn333]

Exactly the above, Jen. If this had happened to someone with very little medical knowledge, the dog would be dead right now.

[krissn333]

And Carol, you have medical knowledge!

[Guest MnMDogs]

And Carol, you have medical knowledge!

Haha- I do, for people. And all the ailments my dogs currently have (Macy's butt lump notwithstanding)...rhabdo, never ever would have crossed my mind, not in the situation Jen described- it's really upsetting that violet was that sick and 2 hours were wasted.

[KF_in_Georgia]

vets are trained to look for the horses and not the zebra and I had a zebra

Jen, you didn't have the zebra. You had the horse he refused to look for. It was the end of August, for cryin' out loud, you told them it was heat-related, and whether they believed that or not, since that's the possibility that was more immediately dangerous than a possible stone, that was the horse they should have been looking for. They should have worked to eliminate that as a possibility rather than simply ignoring it.

Edited September 25, 2013 by KF_in_Georgia

[NeylasMom]

I guess what I'm wondering as I continue to mull this over is whether my expectations are too high. This was not an emergency facility and rhabdomyolysis is, I greatly suspect a very unusual thing to see in a regular vet hospital. I have tried to keep the latter especially in perspective, but I wonder if I'm still being overly critical.

 

Then again, the timing of them closing and the fact that they actually changed the treatment based on the fact that they were closing bugs me increasingly (switching to subQ fluids over IV). Granted, I contributed to the delay in starting the fluids, but if someone had given me the explanation the tech gave me later about IV fluids taking time b/c the rate can only be so high and that if we didn't start them soon the window would close, I am positive I would have said start them. Same thing if they had communicated how long it would actually take to get the blood work results back.

 

Part of me wonders if it wouldn't have just been more responsible of them to have told me they were closing and I should just go to the nearest emergency facility when I called them an hour and 40 minutes before closing to tell them we were on our way with a heat related emergency. My own vet, who I had on the cellphone while we were still on the hike looking up the nearest hospitals had told me about Life Center where we ultimately ended up, but it was an extra 30 minutes from the VCA.

 

This has also just stirred up all of those stressful feelings from when it happened and it's kind of upset me, so I'm not sure how worth it is for me to keep going down this path. But I'm not really one to let things I feel strongly about go so...

Edited September 25, 2013 by NeylasMom

[KF_in_Georgia]

Rhabdomyolysis might be unusual to see at a regular vet hospital only because most owners don't suspect it until the dog has collapsed and is in the ER and the vet tells them what's up.

 

But it is by no means unheard of in high summer, and it's something that every single vet hospital should be considering when there's an emergency visit. For all they knew, it could have been "dog left in parked car" or a similar problem, and it's not as if that's an unheard-of event.

 

In the summer, heat stroke really is a horse, and not a zebra.

 

I agree that they should have sent you on to another hospital--but not when they first had you on the phone because if they believed you that it was heat-related, they could have done something to stabilize her. But clearly they didn't believe you about it being heat-related. And if they believed it was a stone, what did they think they were going to do in 90 minutes?

[tbhounds]

In July I lost my handsome (young) Cavalier Avery. I had taken him to the vet (30 minutes before closing), who ran no test and told me to feed him rice and chicken for a couple of days (he was throwing up and had a very odd diarrhea - even right there in the office the whole time). That evening I woke to him passed out next to me in a pool of blood, I lost him the next day (took him to the ER Vet that time). I blame myself everyday for his death.

 

I have yet to speak to the vet's office, as I am still so angry. Would they even care? I would be interested in knowing too how something like this should be handled.

Holy crapper-I'm sorry-that should never of happened. I would report them to the board.

[GeorgeofNE]

What are you expecting to happen? An apology? A refund?

 

I'd personally write a letter, air my grievance, and find a new vet.

[racindog]

My suggestion is to continue to pursue it no matter what. "Metro" e vets grievously harmed Minny's leg because he was a large guy and non-ambulatory and instead of moving him properly they picked him up and swung him by his hind legs and destroyed his hip joint. He was in excruciating pain from it for the 2 weeks before he crossed over from another cause and it was an additional complication. His vet (use that term loosely in referring to this guy) told me "Its not about compassion." Well they sure proved that! Tragically Cash my sweet little lady hound went down paralyzed at the same time. Both crossed over within ~2 days of each other. As you can imagine I was so upset and as a result did not pursue the negligent manner in which they harmed Minny. I have felt guilty about it ever since. How many others now have they harmed the same way and more than that, Minny deserved for them to be made to answer for what they did to him. It won't happen again. If one of my animals is ever so seriously harmed from their negligence again then a good lawyer will certainly be one of the 1st or 2nd people I call. I learned but too late to get justice for Minny.

[duncan41]

I would contact your State Board of Licensing and find out how to go about filing a complaint (including getting a hold of the required forms), not that you are going to do so immediately, but it might give you a clue about language to use and points to address. The one thing you want to avoid is the "he said / she said" trap. I have not read this entire thread (I did read the entire original thread), but having a complete set of her medical records from the offending facility will be either your best friend or your worst enemy.