Easton Animal Hospital

To Whom it May Concern:
Easton Animal Hospital is in
receipt of [redacted].’s...

complaint (ID# [redacted]) filed with your office regarding
his dog [redacted].  Easton Animal Hospital (EAH)
has prepared this response to address the claims made by [redacted].  The main purpose of preparing this response
is to provide an understanding of why EAH will not consider issuing the refund
requested by [redacted]. for the initial appointment, the surgery, and the follow-up
care.  The following two paragraphs
provide a summary of the circumstances surrounding EAH’s interaction with [redacted]
and her owners.  Dr. C[redacted] had exclusive
interaction with [redacted].; other staff members of EAH had limited interaction
with [redacted]. while [redacted] was under our care, then more extensive interaction
after her discharge.
Dr. C[redacted] saw [redacted] on Monday,
July 28, 2014 for a scheduled sick-patient visit.  [redacted] was brought to EAH by [redacted].’s parents
for vomiting and bloody diarrhea that reportedly started that morning.  Dr. C[redacted] conducted a thorough physical
examination and ordered X-rays, a urinalysis, and blood test to check for
anemia and dehydration.  Dr. C[redacted] reviewed
the X-rays, which revealed bladder stones and an opacity in the intestines suspicious
for a potential blockage or tumor.  Urinalysis
indicated a urinary tract infection.  [redacted]
had a history of bladder stones, of the type which could only be treated with surgical
removal.  Dr. C[redacted] provided palliative
treatment to [redacted] for the vomiting, diarrhea, and urinary tract infection with
instructions for feeding a bland diet and watching for worsening of
gastrointestinal (GI) signs, which would require [redacted] to be rechecked and
additional diagnostics to be done.  Dr.
C[redacted] recommended having the bladder stones removed surgically (cystotomy), as
there is no medical (pharmaceutical) alternative for the type of stone she had
historically.  EAH staff provided a
verbal estimate of $1200-$1500 to [redacted]. that same evening via phone for the cystotomy,
which was required to remove the bladder stones.  An itemized estimate for this procedure (from
which the verbal estimate was quoted) was placed in [redacted]’s file.
[redacted]. returned the following
day with [redacted] for a recheck appointment when her condition did not
improve.  Dr. C[redacted] recommended
proceeding with the cystotomy to remove the bladder stones, as it would also
provide the opportunity to explore the abdomen for the cause of [redacted]’s illness.
 Dr. C[redacted] discussed with [redacted]. the
proposed cystotomy and additional exploratory and informed her that the
original estimate was only for the cystotomy. 
Dr. C[redacted] informed [redacted]. that depending on what was found during the exploratory
portion of the surgery, her cost would be higher.  [redacted]. consented to the surgery and
follow-up care in writing prior to [redacted] being admitted for surgery.  Dr. C[redacted] removed the bladder stones.  The exploratory portion of the surgery
revealed an inconsequential mass outside the intestinal wall (above-mentioned
opacity seen in X-ray) and an inflamed pancreas.  Dr. C[redacted] informed [redacted]. of the results of
the surgery, the need for an additional blood test (cPL) to confirm the
suspicion of pancreatitis, and the need for additional hospitalization and
medical treatment for pancreatitis.  Mrs.
K. consented verbally to the additional work in a post-operative discussion
with Dr. C[redacted] on July 29, 2014.  [redacted]
was treated with a professional standard of care in accordance with [redacted].’s
consent.  Dr. Nankman discharged [redacted] on
Thursday evening, July 31, 2014 with prescriptions for an antibiotic, an
appetite stimulant, anti-vomiting, anti-diarrheal, and pain medications.
The following are EAH’s responses
to the claims made by [redacted]. in his complaint:
1.       [redacted]. claims that EAH did not have authorization to treat [redacted] for the
pancreatitis.   However, [redacted]. signed the consent form on Tuesday,
July 29, 2014 prior to the surgery, which gave EAH permission to perform the
surgery and provide the aftercare (see Attachment 1). In addition, Dr. C[redacted] received verbal
authorization from [redacted]. via phone communication post-operatively (the same
day) to treat the pancreatitis. 
2.       [redacted]. claims that EAH exceeded the estimate of $1,200-$1,500.  That estimate was for a cystotomy, with
standard discharge time the following morning and without complications (see Attachment 2).  EAH verbally provided the estimate for the
cystotomy surgery to [redacted]. on Monday evening July 28, 2014, after the initial
appointment with [redacted].’s parents and before there was any discussion of also
doing an exploratory surgery.  Dr. C[redacted] did
inform [redacted]. at her appointment the following morning, Tuesday, July 29,
2014, prior to the surgery that the exploratory cost was not part of the estimate and, depending on what Dr. C[redacted] found,
the cost would be higher than the estimate.  [redacted]. did not request a revised estimate and
consented to the surgery and appropriate post-operative treatment (depending on
the results of the exploratory) in writing.  The final bill for the cystotomy and the additional
exploratory surgery was $1,499, within the range provided in the estimate.  Additional costs ($563.32) were incurred to
treat the pancreatitis, which was diagnosed during the surgery.  These costs were outside the scope of the estimate
for the cystotomy.  The surgery consent
form signed by [redacted]. specifically authorizes EAH to perform further testing,
treatment, and/or additional surgeries if necessary, and for which the owner is
financially responsible.  (see Attachment 1).  [redacted]. received daily updates from the
doctors who took over [redacted]’s care July 30 and 31 and daily updates on her bill
from the nursing staff (technicians) while [redacted] was hospitalized as is EAH
protocol.  The final bill for [redacted] was $2063.21.  The charges of $563.32 above the estimate were
reasonable and customary for the care [redacted] received for the two additional days
in the hospital.
3.       [redacted]. claims that Dr. C[redacted] misdiagnosed [redacted]’s pancreatitis, when, in fact, it
was the exploratory surgery that led to the diagnosis.  The physical exam findings, x-rays, and
pre-anesthetic bloodwork were not consistent with pancreatitis at the initial
visit.  Dr. C[redacted] met with [redacted]. to
discuss the surgical findings post-operatively (in addition to calling [redacted]. during
the surgery) and informed her that an additional blood test to confirm the pancreatitis
was necessary based on the abnormal appearance of the pancreas.  Once the test was complete, Dr. C[redacted] called [redacted]. to inform her that the pancreatic function test was abnormal (i.e.
pancreatitis) and that [redacted] would require additional time in the hospital as
well as additional medications.  [redacted]. consented
verbally over the phone to proceed with treatment (and, as previously stated,
had signed the consent form to provide this treatment).  While [redacted].’s claim that a simple blood test
could have confirmed pancreatitis has some truth, the statement is oversimplified
and made with 20/20 hindsight; this special pancreatic function test is not run
as part of the routine pre-anesthetic blood screening and Dr. C[redacted] applied a
standard of care consistent within the profession for a patient presenting with
a one day duration of vomiting and diarrhea. Diagnostics, including a physical
examination of [redacted], X-rays, urinalysis, and bloodwork gave no reason to
suspect pancreatitis prior to the surgery and thus did not warrant running a
specialized test as part of the pre-anesthetic blood panel, particularly when that
test can have a false positive result if other GI disease is present, and as
such becomes a red herring.  (A study
published in the March/April 2014 Journal of Veterinary Emergency and Critical
Care found that this simple test “may provide a false positive diagnosis of
pancreatitis in up to 40% of dogs presenting with acute abdominal disease”.)
4.       [redacted] claims that EAH withheld medication from [redacted].  This is false.  Upon discharge of [redacted] on Thursday evening,
July 31, 2014 [redacted]. informed the receptionist that she would not pay more
than $1,500.  There was a balance owed
for the additional hospital stay and medications for the pancreatitis
treatment, which included the medications to be sent home.  When [redacted]. refused to pay her bill in full,
Dr. Nankman prepared written prescriptions so that [redacted]. could have them
filled at a pharmacy of her choosing.  It
is EAH policy that owners be given the opportunity to have medications
dispensed elsewhere with written prescriptions if unable/unwilling to purchase
them from our hospital.  Ultimately, [redacted]. paid her bill in full, minus the medications to be dispensed for home care.  EAH gave [redacted]. another opportunity to have
the prescriptions filled at the hospital, which she declined and took the written
prescriptions with her.
5.       [redacted]. claims that EAH performed an unnecessary surgery.  This is false.  The type of bladder stones [redacted] presented with
required surgical removal, as they had previously.  The purpose of the additional exploratory in
conjunction with the required cystotomy was to attempt to determine what was
making [redacted] ill.  The abnormal X-ray
findings warranted further investigation, particularly after no improvement
with palliative care.  Ultimately, the
surgery was successful in accomplishing both goals: removal of the bladder
stones and diagnosis of the pancreatitis. 
Moreover, both were accomplished within the range of the estimate
provided prior to surgery.
6.       [redacted]. claims that EAH was not properly treating [redacted] for pancreatitis, when, in
fact, EAH’s treatment protocol was consistent with a standard of professional care
and consistent with the treatment she received at the emergency hospital.  [redacted]. also stated [redacted] was “in shock” when
she was admitted to the emergency hospital. 
However, when Dr. C[redacted] followed up with the emergency hospital to
inquire about [redacted]’s condition she spoke with the internal medicine specialist
and the admitting ER doctor.  They
informed Dr. C[redacted] that [redacted] was dehydrated and painful when admitted, but not
in shock.  Paperwork provided to EAH by the
emergency hospital confirmed the conversations Dr. C[redacted] had with the emergency
hospital personnel regarding [redacted]’s stable condition when admitted.  Finally, [redacted].’s final bill from the
emergency hospital was substantially less than the $3000 he claims.  ([redacted]. can provide copies of his invoice
from the emergency hospital verifying this.)
7.       [redacted]. claims that communication with EAH after [redacted] was discharged was lacking.  On the contrary, EAH had frequent (and
documented) communication with him involving multiple staff members. EAH
protocol is for technicians to do the call-backs on patients for updates on
their condition and then relay to the doctor(s) pertinent information or
questions that need to be addressed; this protocol was followed with [redacted], as
it is with every patient that has an illness. 
EAH made repeated attempts to schedule an in-person meeting, at Dr.
C[redacted]’s request, with [redacted]., [redacted]. and the appropriate EAH staff and hospital
owner to discuss the issues he has raised. 
To date [redacted]. has failed to respond to repeated attempts to arrange
such a meeting, and in his last communication with the hospital owner indicated
that he and his wife were not interested in coming in for a meeting as they
felt there is no point in it anymore.
Based on the above, EAH does not
feel that [redacted]. has made a valid request for a refund for the professional
services that EAH provided.  All the
professional services EAH provided were to a professional standard of care.  EAH informed [redacted]. and received her consent
prior to implementation of each phase of the care; therefore we feel that any
refund for services is unwarranted. 
If you have any questions or require any additional information, please do not hesitate to contact me at [redacted] or ###-###-####.
Regards,
Dr. Kelly C[redacted]

Review: My dog [redacted] was brought in to Easton Animal Hospital for an emergency visit, as she had vomited and gone to the bathroom on our home several times while we were out of the house. The vet went over [redacted] and took an x-ray and determined that she had bladder stones...something that she's had issues with before and had surgery for about two years ago. The vet said that the stones had come back...something we had expected at some point, so we weren't surprised, although the symptoms were much different this time. They sent [redacted] home with some medication, but by the next morning she was feeling much worse and not eating at all. My wife took her back to Easton Animal Hospital where they said the surgery to remove the stones was necessary. Of course we gave them the go-ahead as we didn't want to see our dog suffering. They gave us a low estimate and a high estimate, with the understanding that they're not to exceed the high estimate without prior authorization.

During the surgery, the vet called my wife and told her that [redacted] had pancreatitis. She said nothing of additional charges as a result. When my wife went to pick [redacted] up the next day, the bill was over $500 more! The vet, who was not in at the time got on the phone and was annoyed that she had to have the discussion, and told my wife that she should have "inferred from the diagnosis that it would cost more." First of all, they did not get any authorization, and secondly, a diagnosis is very far from an estimate. We reluctantly paid, but the front desk people refused to discharge [redacted] with any medication out of spite, although they did give us written prescriptions to have filled at a local pharmacy. This took several hours with our dog in awful pain. How can a veterinarian who is in the business of helping animals do something so inhumane as withholding medication?

[redacted] spent the entire night crying in pain, and by the next morning was not eating and her eyes looked glassy. She was rushed to a 24 hour emergency facility where they admitted her immediately and said she had a severe case of pancreatitis that was exacerbated by the surgery, and wasn't being treated properly to begin with. She was also going into shock from the terrible pain. [redacted] spent the next three days under round-the-clock care on IV antibiotics and fluids, and finally came home in much better condition, another $3,000 later.

The fact that Easton Animal Hospital misdiagnosed her initial ailment, performed unnecessary surgery and didn't treat the pancreatitis properly was a huge comedy of errors. They only had a vet tech call and check on her twice the first day, and not an actual doctor! I kept telling them that she wasn't eating and was in horrible pain and they told me that this was normal! If we didn't act and take her somewhere else, she most definitely would have died.

I understand mistakes can happen, but this was completely avoidable. Had the doctor done the proper blood work and diagnosed her with pancreatitis before performing surgery, we might not have had to go through this.Desired Settlement: I would like our money refunded from the two visits on Monday July 28, and the surgery performed on July 29. This is approximately $2,400. The inadequate treatment subsequently cost us another $3,000 at another animal hospital to rectify and save our dog's life.

Business

Response: