Mrs. Notesta brought her young cats to our clinic years ago, well before I worked there. At the time, she declined Felv/FIV testing saying, in what typically amounts to a “never”, she wouldn’t test today and that she’d have to think about it. Thankfully, the veterinarian at the time noted this in the record. She declined testing the other 2 cats as well. Fast forward to eight years later when one of Mrs. Notesta’s indoor only cats, Lucky, becomes very ill. She is seen at a local referral center where, over the course of a couple of days she deteriorates and is euthanized. Lab results revealed she had Feline Leukemia Virus (Felv) and it was believed this lead to her death. Felv is not curable or even treatable, leaving cats with a compromised immune system and more likely to develop cancer. Fortunately, none of the other cats in the home were infected.
Mrs. Notesta wrote a letter to the hospital with accusations of negligence and malpractice because her cat was never tested for Felv. She contends that, because Lucky wasn’t tested, the hospital is liable for all medical bills incurred at the referral center, loss of salary for her time off, and other bills accrued during the cat’s illness. Despite having copies of the records with multiple documented refusals and repeated telephone conversations with the practice owner, she announces she will pursue a civil suit against the practice to recover her expenses.
A couple of issues come to mind with this situation:
1. Had the original veterinarian not recommended testing or failed to document her refusal, would Mrs. Notesta have a case?
- Consider how the cat’s medical care would have evolved had veterinarians known she was Felv positive. Perhaps she would have received more aggressive antibiotic treatment when infections were evident. More aggressive treatment early on may have staved off inevitable illness a little longer.
- Would Mrs. Notesta have pursued expensive diagnostics and treatments at the referral center had she known the cat was Felv positive and likely suffering complications of endstage Felv? Probably not. Even if the cat was not tested, testing would not have necessary affected the overall outcome. In the above scenario, is the hospital responsible for her bills if it failed to recommend testing?
I don’t know the answers to these questions but I sure look forward to hearing your opinions
2. How many times should you ask an owner about a specific diagnostic or treatment modality, especially if they say “I’ll have to think about it?”
- The civil court judge in this case ruled that one instance of documentation of the owner’s refusal for Felv/FIV testing 8 years ago was enough even though there were multiple documented refusals. The lawsuit was dropped, the owner paid her bill to the practice, and we haven’t heard from her again.
I think one additional inquiry about testing is warranted from a medical standpoint, if not a legal standpoint, especially if the owner left the conversation with “I need to think about it.”
3. Can clients construe repeated questioning about testing be construed as bullying?
- Maybe. It depends on your approach and the client. If a client senses you’re uncomfortable pressing for an answer they usually become uncomfortable themselves. If a client says no, a reasonable response is “Well, if you ever change your mind and want to do that test let us know” or at an annual visit “Are we still holding off on that heartworm test like we did at your last visit? I certainly recommend the test for Fluffy.”
I am not legal expert and can rarely predict which way the court will rule, but I think veterinarians are probably “safe” recommending testing one time for diseases like heartworm and Felv/FIV provided the recommendation is recorded. Informed owners are key; It’s not enough to merely suggest a test but to explain why that test is important. I talk about heartworm disease in depth at least once, typically at a puppy’s final vaccine appointment. I still recommend testing to owners who have repeatedly declined heartworm testing for their dogs. I also discuss the long term affects of Felv/FIV with new kitten owners prior to recommending testing. I am sure to mention testing twice (if needed) and recommend the test strongly for all strays and all never-previously-seen cats.
Perhaps my approach is overkill, but I feel confident that when Mrs. Notesta writes me a letter, I have myself adequately protected.