Vet did unnecessary $3500 surgery--now what?
September 22, 2014 9:34 PM Subscribe
To make a long story short: my cat got an unnecessary abdominal surgery today and I'm on the hook for $3500 because a radiologist read the ultrasound scan wrong and the vets pushed for emergency surgery as a result. Now what do I do?
After a full abdominal ultrasound this afternoon the radiologist at a veterinary urgent care center said my cat had a 'linear foreign object' stuck in his intestines. They recommended immediate emergency surgery. When it was done the surgeon called and said they found a tiny hairball but no obstruction, not even the bunching the radiologist saw. She threw out the radiologist may have just seen normal intestinal folds as something wrong--then hastily added the radiologist had only said there "might" be a foreign object (there was no "might"--prior to surgery they were confident something was there). My cat got cut open and went through major surgery and I got charged $3500 because their radiologist mistook normal intestinal folds for a foreign object.
Do I have any kind of recourse in this situation? At first I was just happy my cat was OK, but now that the reality of the situation is sinking in I'm getting pretty angry. My cat had been sick for almost a week and the ultrasound came at the recommendation of my normal vet when he'd still been doing poorly on Sunday (the first theory was he just had a hairball stuck in him, which I guess was the case). But after receiving extensive IV fluids from a [i]different[/i] urgent care place Sunday evening (long story, I got sent on a wild goose chase looking for a place that does Sunday ultrasounds) he was doing much better today, eating, drinking, walking around and looking for attention. I was considering not taking him to the urgent care center at all. My regular vet pushed me to get it just in case. If the radiologist had not read that scan wrong my cat would be back here, continuing to get better, rather than scared, alone, and cut open in a hospital and facing two weeks of forced bed rest plus whatever additional recovery.
I understand there are risks associated with surgery, but is "hey we can't read an ultrasound so this surgery totally wasn't necessary" a risk I'm supposed to have accepted?
After a full abdominal ultrasound this afternoon the radiologist at a veterinary urgent care center said my cat had a 'linear foreign object' stuck in his intestines. They recommended immediate emergency surgery. When it was done the surgeon called and said they found a tiny hairball but no obstruction, not even the bunching the radiologist saw. She threw out the radiologist may have just seen normal intestinal folds as something wrong--then hastily added the radiologist had only said there "might" be a foreign object (there was no "might"--prior to surgery they were confident something was there). My cat got cut open and went through major surgery and I got charged $3500 because their radiologist mistook normal intestinal folds for a foreign object.
Do I have any kind of recourse in this situation? At first I was just happy my cat was OK, but now that the reality of the situation is sinking in I'm getting pretty angry. My cat had been sick for almost a week and the ultrasound came at the recommendation of my normal vet when he'd still been doing poorly on Sunday (the first theory was he just had a hairball stuck in him, which I guess was the case). But after receiving extensive IV fluids from a [i]different[/i] urgent care place Sunday evening (long story, I got sent on a wild goose chase looking for a place that does Sunday ultrasounds) he was doing much better today, eating, drinking, walking around and looking for attention. I was considering not taking him to the urgent care center at all. My regular vet pushed me to get it just in case. If the radiologist had not read that scan wrong my cat would be back here, continuing to get better, rather than scared, alone, and cut open in a hospital and facing two weeks of forced bed rest plus whatever additional recovery.
I understand there are risks associated with surgery, but is "hey we can't read an ultrasound so this surgery totally wasn't necessary" a risk I'm supposed to have accepted?
Yeah, that's bs if they definitely said there was a foreign object and are now back pedaling. Are there any xrays?. Write everything that happened down now and email it to your regular vet or lawyer or someone so there is a record. Contact the clinic and let them know you are unhappy in case they miraculously feel like making good. Request the stills they captured during the scan, via email if you can. Unfortunately with ultrasound there may be no "scan" since the radiologist usually reads the screen as they are doing it. But they almost certainly took still shots.
Some emergency care places are sketchball businesses notorious for pressuring caring owners Into stuff like this. One did it to my elderly father and I looked up how many prior complaints they had, called them up, talked to the vet in question and threatened to file a criminal complaint as well as take them to small claims and go to the veterinary board for the state. I had the blow by blow via text and email from my dad as it was all happening and I pointed out the inconsistencies. They called my Dad an hour later and said it was their mistake, and refunded his money. I believe the vet sucked it up
In that case, they had a litany of prior complaints and also the vet was not an owner so has no incentive to put their license on the line.
Be warned your regular vet is very unlikely to help you out or give you any kind of definitive statement regarding standard of care. They 99% will not support a legal action unless you subpoena them or something totally over the top you're not going to do. And I say this as someone who has two close friends who are vets, several family members and has spent more time and money on vet care than I care to think in my life. The vet world is a small world.
posted by fshgrl at 9:58 PM on September 22, 2014 [1 favorite]
Some emergency care places are sketchball businesses notorious for pressuring caring owners Into stuff like this. One did it to my elderly father and I looked up how many prior complaints they had, called them up, talked to the vet in question and threatened to file a criminal complaint as well as take them to small claims and go to the veterinary board for the state. I had the blow by blow via text and email from my dad as it was all happening and I pointed out the inconsistencies. They called my Dad an hour later and said it was their mistake, and refunded his money. I believe the vet sucked it up
In that case, they had a litany of prior complaints and also the vet was not an owner so has no incentive to put their license on the line.
Be warned your regular vet is very unlikely to help you out or give you any kind of definitive statement regarding standard of care. They 99% will not support a legal action unless you subpoena them or something totally over the top you're not going to do. And I say this as someone who has two close friends who are vets, several family members and has spent more time and money on vet care than I care to think in my life. The vet world is a small world.
posted by fshgrl at 9:58 PM on September 22, 2014 [1 favorite]
When my cat went to urgent care, they took x-rays that were later given to my vet for the cat's records, on a CD. The presentation of the data on the CD looks very much like it's some fancy radiology imaging, requiring a viewer and software and whatnot. They were just JPEGs. So first, talk to your vet about getting those images for the cat's file, before discussing the outcome and possible lawsuit.
It's possible that the radiologist made an honest mistake. Our urgent care vet showed us the images then and there, pointed out possible obstructions, but overall communicated that it's a big mess of tubes that can be difficult to discern anything less obvious than a nailfile. In our case there was no freakout and no emergency surgery. But any vet can look at the images and say "that obviously looks like an obstruction" or (as my cousin, our go-to-second-opinion vet did) say "Yeah, can't really tell anything from that".
Vets and other medical professionals can certainly overstate risks in order to justify pricey procedures to keep themselves busy. You're angry, justifiably, but now's the time to control your anger and get your ducks in a row. You want those images (without having to force them out of the vet), and you want another vet to give you an honest second opinion on whether or not they justify surgery. If you get those, you've got all the ammunition you need to go after the urgent care vet. But if you solicit the opinion as "please explain to me how these images could lead to emergency surgery", you might get an explanation that makes sense, and you don't want your anger to get in the way of hearing a solid professional opinion.
I'm sorry your cat went through this. When Bergamot spent a day vomiting and not eating, my wife and I were freaking out. I can't imagine how much worse surgery would be on top of all that, especially if it seems totally unnecessary.
posted by fatbird at 10:17 PM on September 22, 2014 [5 favorites]
It's possible that the radiologist made an honest mistake. Our urgent care vet showed us the images then and there, pointed out possible obstructions, but overall communicated that it's a big mess of tubes that can be difficult to discern anything less obvious than a nailfile. In our case there was no freakout and no emergency surgery. But any vet can look at the images and say "that obviously looks like an obstruction" or (as my cousin, our go-to-second-opinion vet did) say "Yeah, can't really tell anything from that".
Vets and other medical professionals can certainly overstate risks in order to justify pricey procedures to keep themselves busy. You're angry, justifiably, but now's the time to control your anger and get your ducks in a row. You want those images (without having to force them out of the vet), and you want another vet to give you an honest second opinion on whether or not they justify surgery. If you get those, you've got all the ammunition you need to go after the urgent care vet. But if you solicit the opinion as "please explain to me how these images could lead to emergency surgery", you might get an explanation that makes sense, and you don't want your anger to get in the way of hearing a solid professional opinion.
I'm sorry your cat went through this. When Bergamot spent a day vomiting and not eating, my wife and I were freaking out. I can't imagine how much worse surgery would be on top of all that, especially if it seems totally unnecessary.
posted by fatbird at 10:17 PM on September 22, 2014 [5 favorites]
Yes, I'm not saying that this vet deliberately took advantage, it could have been an honest mistake. It probably was not a ploy to do unnecessary surgery. But they should have been much more upfront with you about the maybes ahead of time, and definitely shouldn't be backpedaling the way they are now.
You paid for a scan to see if there was a blockage, there wasn't but you were told there definitely was. Focus on that aspect.
Second opinions are nice but don't expect one you can use in a court of law.
posted by fshgrl at 10:40 PM on September 22, 2014 [2 favorites]
You paid for a scan to see if there was a blockage, there wasn't but you were told there definitely was. Focus on that aspect.
Second opinions are nice but don't expect one you can use in a court of law.
posted by fshgrl at 10:40 PM on September 22, 2014 [2 favorites]
I would agree with fatbird. I'm a human physician, and mistakes get made sometimes in our realm too (i.e. things that looked scary can turn out to be not scary, procedures can be done based on faulty information), and it isn't necessarily malpractice. Calling it malpractice suggests that there was a gross error made - i.e. the radiologist should have been able to tell that the ultrasound was normal and other radiologists would not have made the same mistake (which is what fatbird suggests you determine), or the situation was purposefully made to look worse than it was to get you to pay for an unnecessary procedure.
When you get a copy of the images, you'll also want the radiology report itself to see the wording they used. Radiologists often hedge/waffle with their language in the reading to cover themselves in case something like this comes up, i.e. "There appears to be a linear foreign object in the intestines at location X. Please correlate clinically". This would give you a sense of the latter aspect of possible malpractice that I mentioned - whether it seems like your doctor reacted appropriately to the reading given the context of the situation. You'll need a professional opinion to determine this. No one here on the internet should feel comfortable telling you this was malpractice. We don't have enough information to determine that.
posted by treehorn+bunny at 10:43 PM on September 22, 2014 [14 favorites]
When you get a copy of the images, you'll also want the radiology report itself to see the wording they used. Radiologists often hedge/waffle with their language in the reading to cover themselves in case something like this comes up, i.e. "There appears to be a linear foreign object in the intestines at location X. Please correlate clinically". This would give you a sense of the latter aspect of possible malpractice that I mentioned - whether it seems like your doctor reacted appropriately to the reading given the context of the situation. You'll need a professional opinion to determine this. No one here on the internet should feel comfortable telling you this was malpractice. We don't have enough information to determine that.
posted by treehorn+bunny at 10:43 PM on September 22, 2014 [14 favorites]
By the way, you'll want to clarify what the diagnosis was. Was it a linear foreign body, an intestinal obstruction, or both? They're two different things.
posted by treehorn+bunny at 10:44 PM on September 22, 2014 [4 favorites]
posted by treehorn+bunny at 10:44 PM on September 22, 2014 [4 favorites]
Personally, I think it is better to have a negative exploratory laparotomy than a positive necropsy.
None of us were present for your interactions so who can tell how confident they were about the radiographs? And when we suggest an emergency procedure, we often have miscommunications with clients; it's an emergency, and they are often anxious.
As treehorn+bunny said, none of us have enough information.
I would suggest that you arrange for a meeting with the veterinarian, get your paperwork and diagnostic materials for transfer back to your regular vet, and tell them that you don't understand what happened with your cat's surgery. Ask them to go through the case with you, show you the radiographs. Gauge their level of confidence. Try to stay calm and level headed and shoot for a sympathetic response.
I hope your kitty cat is doing well. I hope that you are right; that he was getting better immediately prior to his surgery. A negative explore just rules a foreign body; there may be some other underlying cause for your cat's malaise.
posted by Seppaku at 11:09 PM on September 22, 2014 [9 favorites]
None of us were present for your interactions so who can tell how confident they were about the radiographs? And when we suggest an emergency procedure, we often have miscommunications with clients; it's an emergency, and they are often anxious.
As treehorn+bunny said, none of us have enough information.
I would suggest that you arrange for a meeting with the veterinarian, get your paperwork and diagnostic materials for transfer back to your regular vet, and tell them that you don't understand what happened with your cat's surgery. Ask them to go through the case with you, show you the radiographs. Gauge their level of confidence. Try to stay calm and level headed and shoot for a sympathetic response.
I hope your kitty cat is doing well. I hope that you are right; that he was getting better immediately prior to his surgery. A negative explore just rules a foreign body; there may be some other underlying cause for your cat's malaise.
posted by Seppaku at 11:09 PM on September 22, 2014 [9 favorites]
Check YELP and other review sites for this business.
If there are other similar complaints, yep, you probably have a case.
IANAL, but I occasionally am familiar with their ways.
The sad fact is that LOTS of vets and urgent pet care places do stuff like this. Sometimes the care is honest because animals can not verbalize about their symptoms and there is "best" guess work involved on the part of the professionals involved.
However.
Vets are a business. My direct understanding is that the way their business works, profit is low, effort is high. Sometimes certain facilities do Bad Things to increase their profits.
----
Only another veterinary medical doctor trained at reading feline ultrasounds can give you an idea whether or not this surgery was an emergency, or even necessary.
Nthing that you should get copies of the scans and proceed from there.
posted by jbenben at 11:38 PM on September 22, 2014
If there are other similar complaints, yep, you probably have a case.
IANAL, but I occasionally am familiar with their ways.
The sad fact is that LOTS of vets and urgent pet care places do stuff like this. Sometimes the care is honest because animals can not verbalize about their symptoms and there is "best" guess work involved on the part of the professionals involved.
However.
Vets are a business. My direct understanding is that the way their business works, profit is low, effort is high. Sometimes certain facilities do Bad Things to increase their profits.
----
Only another veterinary medical doctor trained at reading feline ultrasounds can give you an idea whether or not this surgery was an emergency, or even necessary.
Nthing that you should get copies of the scans and proceed from there.
posted by jbenben at 11:38 PM on September 22, 2014
My puppy thought bringing me dead birds was the thing to do. Sometimes they were live. She started vomiting after every meal. She had avian worms in her system and nobody figured that out until 2000 dollars worth of surgery. Deworming would have been an oral dose for 15 dollars.
The vet missed it and it was an intern who spotted those tiny worms. It took some negotiating, but we got free veterinary care for a long time after that.
posted by Mr. Yuck at 4:49 AM on September 23, 2014 [6 favorites]
The vet missed it and it was an intern who spotted those tiny worms. It took some negotiating, but we got free veterinary care for a long time after that.
posted by Mr. Yuck at 4:49 AM on September 23, 2014 [6 favorites]
A payment plan or negotiation of fees might be possible, and I realize this is a big hit for both you and the cat. At the same time, all, let's not to lose sight of the important thing: schroedinger's cat is alive!
posted by JMOZ at 6:05 AM on September 23, 2014 [10 favorites]
posted by JMOZ at 6:05 AM on September 23, 2014 [10 favorites]
I think it's fine to get copies of the scans and get a second opinion, but keep in mind that if this place were really trying to pull one over on you, they easily could have said "Hey, good thing we did that surgery! We removed a dangerous object and it could have killed her if we had not done the surgery." I mean, you weren't in there during the surgery, so how would you ever know? The fact that they are coming clean about the error now at least says something for their honesty. With any sort of imaging, errors are always possible and it could be an honest mistake. This doesn't mean you shouldn't fight it, but I would approach it with the attitude that you don't KNOW for sure that something out of line happened.
posted by rainbowbrite at 8:05 AM on September 23, 2014 [1 favorite]
posted by rainbowbrite at 8:05 AM on September 23, 2014 [1 favorite]
Response by poster: I don't think they were trying to pull one over on me. I think they made a mistake. I talked with the surgeon today and she hemmed and hawed about the inexact nature of medical science--but literally the only reason I agreed to surgery was because they emphasized the presence of this "linear foreign body" and the necessity of emergency surgery. My cat was on such a dramatic upswing that I was surprised anything was found at all, but I trusted their judgement. There was little to no equivocation in the radiologist's report about the presence of an object.
The surgeon tried to claim that now we know for sure nothing's wrong and they're doing biopsies to make sure there's no IBD or cancer, but those weren't considered high risks in the first place.
I would like to try for a negotiation of the bill. How should I approach it?
posted by Anonymous at 10:37 AM on September 23, 2014
The surgeon tried to claim that now we know for sure nothing's wrong and they're doing biopsies to make sure there's no IBD or cancer, but those weren't considered high risks in the first place.
I would like to try for a negotiation of the bill. How should I approach it?
posted by Anonymous at 10:37 AM on September 23, 2014
Response by poster: I explained to the vet if it had been 50-50 or even 70-30 given my cat's improvement I would have not gone for the surgery. But they were very confident in their recommendation. She admitted in the future with other clients they will "talk in percentages".
posted by Anonymous at 10:39 AM on September 23, 2014
posted by Anonymous at 10:39 AM on September 23, 2014
I would like to try for a negotiation of the bill. How should I approach it?
Not to sound flippant, but the straight answer is "with a lawyer", or at least the threat thereof. Whether you wind up suing them or not, you're at least gonna have to scare them if you want jack shit. Otherwise they have no incentive to bill you any less.
posted by Itaxpica at 10:43 AM on September 23, 2014
Not to sound flippant, but the straight answer is "with a lawyer", or at least the threat thereof. Whether you wind up suing them or not, you're at least gonna have to scare them if you want jack shit. Otherwise they have no incentive to bill you any less.
posted by Itaxpica at 10:43 AM on September 23, 2014
Disagree regarding lawyer. They do have incentive to accept less - it costs them time and money to get you to pay. it's the same story as with regular medical billing. If you tell them given the error you're willing to pay $X and you will pay right now in cash if they accept your offer, they will be motivated to consider it, I bet. The other motivation is that veterinary medicine is a cash only business and they need their customers to be satisfied. If you seem on the verge of telling everyone you know about their screw up, they will want to make you happy to try to avoid that.
posted by treehorn+bunny at 12:04 PM on September 23, 2014
posted by treehorn+bunny at 12:04 PM on September 23, 2014
Ask them to waive the surgical fees. Be super-polite, and assume good will. Doctor, you really urged me to have the surgery, and you were quite definite that there was a foreign object. My cat has had unnecessary surgery and recuperation. Thankfully, she's doing well, but the surgery had risks. I don't think I should have to pay for a misread scan. Of course, I understand that people make mistakes, but people should accept responsibility for their mistakes and go from there. You may be very uneasy about confrontation. Practice with a friend if it will help. Somebody made an error, your cat had unnecessary surgery, they should be willing to work it out.
posted by theora55 at 12:44 PM on September 23, 2014 [1 favorite]
posted by theora55 at 12:44 PM on September 23, 2014 [1 favorite]
Response by poster: Sorry, one more question. They had me put a 75% deposit down on CareCredit and they have my card number. I can't really withhold any payment since they already charged me most of it. I'm supposed to pick my cat up tonight. Do I pay and talk about refund later? If they refuse to negotiate they have my cat, right?
posted by Anonymous at 1:26 PM on September 23, 2014
posted by Anonymous at 1:26 PM on September 23, 2014
Given the update, I think this reduces your leverage. However, I also don't think it hurts to ask politely and to push a little. What do you have to lose? I am guessing you will not be returning to this vet in the future regardless of the outcome of the bill, so you don't need to preserve a healthy relationship here.
posted by rainbowbrite at 3:31 PM on September 23, 2014 [1 favorite]
posted by rainbowbrite at 3:31 PM on September 23, 2014 [1 favorite]
If it comes down to it, know that there are lawyers who specialize in Animal Law. That's the kind of attorney I would recommend.
posted by tacodave at 3:51 PM on September 23, 2014 [1 favorite]
posted by tacodave at 3:51 PM on September 23, 2014 [1 favorite]
Medical mistakes suck, and suck bad -- but they aren't malpractice. Sometimes people just fuck up. We had a family practice radiologist badly misread an x-ray of my daughter's intestines, fortunately in a way that didn't necessitate an unnecessary abdominal surgery, but to a similarly flabbergasting extent.
Given the circumstances, I think negotiating the bill is 100% appropriate, and your argument should leverage not the fact of the misdiagnosis but rather the overstatement of the certainty of the case.
posted by KathrynT at 9:31 AM on September 24, 2014
Given the circumstances, I think negotiating the bill is 100% appropriate, and your argument should leverage not the fact of the misdiagnosis but rather the overstatement of the certainty of the case.
posted by KathrynT at 9:31 AM on September 24, 2014
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posted by marsbar77 at 9:49 PM on September 22, 2014 [4 favorites]