Veterinary Specialist of Rochester

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear belowThis responds doesn't resolve the fact that they charged $to do nothing to the dog! Regards, [redacted]

Thank you for contacting us in regards to case number [redacted] .As you are aware, this patient presented to us the evening of August 17, with the concern that he had been straining in the litter box and subsequently collapsed after leaving the litter boxUpon initial triage and examination the patient was stable with vital signs other than a mild fever and some excitement from his ride in the carThe patient had urinated in his carrier on the way in, and urinated again on the table as we were triaging/examining himThe owner was advised that based on the symptoms and the patient's physical exam, I was concerned about urinary tract issuesI recommended a urinalysis be performedThe owner agreedWe obtained and submitted the urine sample and continued to monitor the patientWhile awaiting the results of the urinalysis, the owner elected to leave the hospital for a short timeWhen he returned, we were unfortunately quite busy with new emergencies, and I was unable to speak with him right away.I did meet with the owner as soon as I was able, and apprised them of the findings of the urinalysis, which were consistent with idiopathic cystitis, a common condition in male catsI explained that while cystitis is common in male cats, the fever was unusual, and that I was starting him on antibiotics as a precautionI also explained that the episode of collapse was suspected to be a vagal response to the patient's straining in the litter box, as increased abdominal pressure/tone can sometimes cause nausea and a "light headed" feelingWe discussed cystitis and I warned the owner that although the patient was not obstructed at the time of his visit, it would be very important for him to be vigilant about the cat's urination at home, because cats with cystitis are always at risk of obstructionThe owner was given handouts with detailed information about cystitis and urethral obstructionThe patient was discharged with instructions for owner to phone his veterinarian the next day to discuss changing the cat's diet, as a large part of this problem is attributable to an excess amount of mineral crystals in the urineThis aspect of cystitis is manageable with a specialized dietWe encourage owners to work with their regular vet when determining the best prescription diet, as this is an aspect of chronic disease management and we are an emergency facilityThe records were faxed to the patient's regular vet once they were completed that evening, to ensure that they had a copy of the urinalysis results when the owner called.The client was charged for an examination, the urinalysis, and the antibiotics.Please let me know if I may be of further assistance.Kimberly D, DVM

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint in scope or legitimacyFor your reference, details of the offer I reviewed appear below The Hospital's MD gave us a low and high estimate, the closing amount far exceeded that estimateWhat was the point of a high estimate if it could not be relied uponI believe there is a total disregard for heaping on additional costly medical expense because the hospital knew our beloved Bella would not survive and we were a captive audienceIf a high and low estimate are given as a matter of hospital policy to patients weighing medical intervention, what is the point if it cannot be relied uponI believe the hospital owes us a refund to some degree Regards, [redacted] ***

To Whom It May Concern, [redacted] is a 9 year old MN Lhasa Apso who presented after a transfer call from Dr. R [redacted] . She expressed that [redacted] no longer had deep pain present in his hind limbs, therefore advanced diagnostic imaging and subsequent surgical correction (if determined to be a... surgical lesion) was recommended. An estimate of $5000-7000 was given that included MRI and surgery. It was discussed that both MRI and surgery are done under the same anesthesia in order to minimize risk to the patient.On presentation [redacted] still had deep pain present in both pelvic limbs, however no motor function was present and conscious proprioception deficits were noted. I spoke with the owners and recommended MRI +/- surgical intervention based on the results of the imaging. I explained that if the MRI shows IVDD then most likely a hemilaminectomy will be recommended and will be performed immediately after MRI under the same anesthesia. The owners expressed that they only wanted and MRI and refused to commit to the surgery even if the lesion was surgical. They also expressed that they had never received an estimate prior to transfer.I reiterated that at here at VSES we will not perform an MRI without consent to continue on to surgical intervention. This is because it is not considered an appropriate standard of care as anesthesia is a risk to the patient in itself and it also relaxes the muscles around the vertebral column that may be protecting the lesion. Therefore in order to minimize risk to the patient and worsening his current condition, we cannot perform the MRI without consent to continue to surgery if needed. Again the owners refused. Mr. R [redacted] expressed that he did not feel that [redacted] was worth $7000 and Mrs. R [redacted] felt that [redacted] was. I expressed that [redacted] is at a critical point in the disease process where if the lesion is determined to be intervertebral disc disease and surgical intervention is not pursued then his neurological function is likely to worsen.Successful surgical outcomes in dogs with intact deep nocioception range from 72%-100%. Those patients that advance in their disease process to losing deep nocioception decrease their success rate to 25%-78% chance of return to ambulation.At this time, the R [redacted] family demanded their dog back and refused all further diagnostics and treatment. They expressed that they would like to try laser therapy and acupuncture again with their primary care veterinarian.Dr. R [redacted] called during the end of their visit and wanted to clarify why [redacted] could not recieve only an MRI. I expressed that I felt the communication was that it was in the patients' best interest to have an MRI and surgical correction performed here and that is what was communicated to the owners as well as the estimate. Dr. R [redacted] expressed that she thought it was an option to have [redacted] transferred back so that he could have surgery performed at Orchard Park. I explained that typically we only make that arrangement when a surgeon from that practice contacts us requesting an MRI with the intent for the patient to immediately return for surgery. This is also not commonly done on an emergency basis and would be considered an outpatient MRI. If there is no intention for [redacted] to have surgery then he can be medically managed at return as an outpatient MRI or be hospitalized until an MRI can be performed during normal operating hours. Dr. R [redacted] said she understood and would speak to the R [redacted] family Prior to discharge, I recommended that [redacted] be on strict cage rest for 4-6 weeks. They can continue to administer the analgesia medications as previously prescribed by their primary care veterinarian. I also recommended that his urination habits be monitored and ensure he is able to urinate appropriately. If he is unable to urinate on his own for 24 hours then this is a medical emergency and I recommend seeking veterinary advice immediately. A sling is also recommended to aid in walking. Unfortunately I was unable to have further discussion with the R [redacted] family because they were upset about having to wait and demanded their dog in order to leave. Dr. Jessica Y***

Mr. [redacted]:I received a copy of your complaint and the subsequent responses this afternoon (4/13/16).  When [redacted] arrived at VSES, he was examined by one of our doctors who then discussed their diagnosis, possible treatment options and the cost of those with you.  The $110 fee you were charged was specifically for the examination, which is a service you received.I would like to discuss this with our Emergency Services Director tomorrow to more fully understand the circumstances and communications that took place.  At that time, I will reach out to communicate to you what I find and to discuss possible options with you.  In the meantime, I do hope that [redacted] is doing better.Sincerely,MikeMichael O[redacted]Director of Hospital Operations, VSES

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below. This responds doesn't resolve the fact that they charged $110.00 to do nothing to the dog! 
Regards,
[redacted]

The cost of care can vary day to day based on the approved treatments administered on any given day, different treatments are given on different days and some just one time. The estimates are intended to reflect the entire course of treatment, therefore you cannot look at an estimate on a daily...

average. The client also approved a higher cost treatment ([redacted]). The estimates are designed to be just that, estimates. As charges (based on actual tests, hospitalization stay and treatments) are entered the actual cost is determined and should fall within the estimate. The logic as indicated in the complaint relating to average cost per day and averaging the low end and high end of the estimate would therefore not apply. An itemized listing of all charges was provided to the client. The Hospital Manager had multiple conversations with the client as well as a meeting with him, the Medical Director and the doctor in which this was all explained and the chart and expenses were reviewed.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint in scope or legitimacy. For your reference, details of the offer I reviewed appear below.  The Hospital's MD gave us a low and high estimate, the closing amount far exceeded that estimate. What was the point of a high estimate if it could not be relied upon. I believe there is a total disregard for heaping on additional costly medical expense because the hospital knew our beloved Bella would not survive and we were a captive audience. If a high and low estimate are given as a matter of hospital policy to patients weighing medical intervention, what is the point if it cannot be relied upon. I believe the hospital owes us a refund to some degree.
Regards,
[redacted]

Thank you for contacting us in regards to case number [redacted].As you are aware, this patient presented to us the evening of August 17, 2015 with the concern that he had been straining in the litter box and subsequently collapsed after leaving the litter box. Upon initial triage and...

examination the patient was stable with normal vital signs other than a mild fever and some excitement from his ride in the car. The patient had urinated in his carrier on the way in, and urinated again on the table as we were triaging/examining him. The owner was advised that based on the symptoms and the patient's physical exam, I was concerned about urinary tract issues. I recommended a urinalysis be performed. The owner agreed. We obtained and submitted the urine sample and continued to monitor the patient. While awaiting the results of the urinalysis, the owner elected to leave the hospital for a short time. When he returned, we were unfortunately quite busy with new emergencies, and I was unable to speak with him right away.I did meet with the owner as soon as I was able, and apprised them of the findings of the urinalysis, which were consistent with idiopathic cystitis, a common condition in male cats. I explained that while cystitis is common in male cats, the fever was unusual, and that I was starting him on antibiotics as a precaution. I also explained that the episode of collapse was suspected to be a vagal response to the patient's straining in the litter box, as increased abdominal pressure/tone can sometimes cause nausea and a "light headed" feeling. We discussed cystitis and I warned the owner that although the patient was not obstructed at the time of his visit, it would be very important for him to be vigilant about the cat's urination at home, because cats with cystitis are always at risk of obstruction. The owner was given handouts with detailed information about cystitis and urethral obstruction. The patient was discharged with instructions for owner to phone his veterinarian the next day to discuss changing the cat's diet, as a large part of this problem is attributable to an excess amount of mineral crystals in the urine. This aspect of cystitis is manageable with a specialized diet. We encourage owners to work with their regular vet when determining the best prescription diet, as this is an aspect of chronic disease management and we are an emergency facility. The records were faxed to the patient's regular vet once they were completed that evening, to ensure that they had a copy of the urinalysis results when the owner called.The client was charged for an examination, the urinalysis, and the antibiotics.Please let me know if I may be of further assistance.Kimberly D, DVM

To Whom It May Concern, [redacted] is a 9 year old MN Lhasa Apso who presented after a transfer call from Dr. R[redacted]. She expressed that [redacted] no longer had deep pain present in his hind limbs, therefore advanced diagnostic imaging and subsequent surgical correction (if determined to be a...

surgical lesion) was recommended. An estimate of $5000-7000 was given that included MRI and surgery. It was discussed that both MRI and surgery are done under the same anesthesia in order to minimize risk to the patient.On presentation [redacted] still had deep pain present in both pelvic limbs, however no motor function was present and conscious proprioception deficits were noted. I spoke with the owners and recommended MRI +/- surgical intervention based on the results of the imaging. I explained that if the MRI shows IVDD then most likely a hemilaminectomy will be recommended and will be performed immediately after MRI under the same anesthesia. The owners expressed that they only wanted and MRI and refused to commit to the surgery even if the lesion was surgical. They also expressed that they had never received an estimate prior to transfer.I reiterated that at here at VSES we will not perform an MRI without consent to continue on to surgical intervention. This is because it is not considered an appropriate standard of care as anesthesia is a risk to the patient in itself and it also relaxes the muscles around the vertebral column that may be protecting the lesion. Therefore in order to minimize risk to the patient and worsening his current condition, we cannot perform the MRI without consent to continue to surgery if needed. Again the owners refused. Mr. R[redacted] expressed that he did not feel that [redacted] was worth $7000 and Mrs. R[redacted] felt that [redacted] was. I expressed that [redacted] is at a critical point in the disease process where if the lesion is determined to be intervertebral disc disease and surgical intervention is not pursued then his neurological function is likely to worsen.Successful surgical outcomes in dogs with intact deep nocioception range from 72%-100%. Those patients that advance in their disease process to losing deep nocioception decrease their success rate to 25%-78% chance of return to ambulation.At this time, the R[redacted] family demanded their dog back and refused all further diagnostics and treatment. They expressed that they would like to try laser therapy and acupuncture again with their primary care veterinarian.Dr. R[redacted] called during the end of their visit and wanted to clarify why [redacted] could not recieve only an MRI. I expressed that I felt the communication was that it was in the patients' best interest to have an MRI and surgical correction performed here and that is what was communicated to the owners as well as the estimate. Dr. R[redacted] expressed that she thought it was an option to have [redacted] transferred back so that he could have surgery performed at Orchard Park. I explained that typically we only make that arrangement when a surgeon from that practice contacts us requesting an MRI with the intent for the patient to immediately return for surgery. This is also not commonly done on an emergency basis and would be considered an outpatient MRI. If there is no intention for [redacted] to have surgery then he can be medically managed at return as an outpatient MRI or be hospitalized until an MRI can be performed during normal operating hours. Dr. R[redacted] said she understood and would speak to the R[redacted] family Prior to discharge, I recommended that [redacted] be on strict cage rest for 4-6 weeks. They can continue to administer the analgesia medications as previously prescribed by their primary care veterinarian. I also recommended that his urination habits be monitored and ensure he is able to urinate appropriately. If he is unable to urinate on his own for 24 hours then this is a medical emergency and I recommend seeking veterinary advice immediately. A sling is also recommended to aid in walking. Unfortunately I was unable to have further discussion with the R[redacted] family because they were upset about having to wait and demanded their dog in order to leave. Dr. Jessica Y[redacted]