Can I have the rest of the bottle?

RE: Can I have the rest of the bottle?

Virginia Campbell — Fri, 28 Sep 2018 22:57:30 GMT

[quote user="Neil Wheadon"]

The client simply asked 'I want the rest' and is quite insistent.

[/quote]

The client can get up the yard IMO.

(Not even a "Please may I have..?" Honestly. My granny would have been appalled. The answer to "I want" was always "You'll have to want, then" when I was wee.).

RE: Can I have the rest of the bottle?

Evelyn Barbour-Hill — Tue, 25 Sep 2018 21:29:24 GMT

[quote user="Neil Wheadon"] sought the opinion of 8 vets and all would do the same thing [/quote]

see, it's a conspiracy, b****y vets!

RE: Can I have the rest of the bottle?

Neil Wheadon — Tue, 25 Sep 2018 21:04:10 GMT

This thread really helped with this decision.

I was well and truly placed on the spot by this client, there were excellent notes but it was in the middle of a busy evening surgery and having questioned my dose (you need to give half second time - wrong) the client threw this at me and it took 10 minutes to get her/him out the door as he/she repeatedly asked why.

I left a message on the answerphone saying I'd sought the opinion of 8 vets and all would do the same thing and quoted the 'animal under my care' for good measure

So thank you everyone

Neil

RE: Can I have the rest of the bottle?

vs0u — Tue, 25 Sep 2018 20:26:34 GMT

Surely it would be illegal to give the client the rest of the bottle. It has to be prescribed for a specific animal and he doesn't have one that needs it.

Different rules apply for farmers perhaps but with the same drug and a farmer with only one dog, I still don't think I'd give it them!

RE: Can I have the rest of the bottle?

Bob Russell — Mon, 24 Sep 2018 11:21:58 GMT

Teach me to read the post!

No, I would never hand over a bottle of a POM injection to a dog owner. I would treat a farmer slightly differently as they are professional animal keepers.

I would keep the bottle and label it on behalf of the owner if they were really that bothered on the off chance that they might require future doses within the next 28 days. After that I would dispose of the bottle.

I would offer to credit a particularly obstinate owner should more of the bottle be used within the permitted timescale. You never know he may know another 20 owners and that would mean 20 consultation charges!!!!!

All very unlikely but the bottle has been paid for.

What is he going to use it for anyway? Nothing legitimate that I can see.

Edit: I agree wholeheartedly that the use of multidose bottles for companion animal practice should be very limited and it should be the VMD that are pushing for this.

RE: Can I have the rest of the bottle?

David Mills — Sun, 23 Sep 2018 23:59:18 GMT

*may* have a dog with Babesia, but very probably not. So if you could hang tight for a poor charity vet...

RE: Can I have the rest of the bottle?

Phil Fox-Manning — Sun, 23 Sep 2018 22:54:53 GMT

Charging full price to the client doesnt mean they own the bottle - they have been prescribed their required dose, and the price just happens to be that way because of the cost to you as the prescribing vet. I absolutely agree with splitting the cost of a bottle if more than one client requires treatment, but I wouldn’t dispense an injectable medication to an owner out of a sense of ‘obligation’ to them... it’s yours, you supplied it, and charged it at “the going rate” - just like any other company assuming a degree of wastage and increasing price of items sold to cover this

RE: Can I have the rest of the bottle?

Michael Woodhouse — Sat, 22 Sep 2018 22:03:48 GMT

[quote user="Anthony Todd"]Michael, why do you disagree?[/quote]

Because I do! We've discussed this before - I don't want injecting with a drug that has sat open on a shelf for months, and I don't want you giving it to my dog either. Look what happens to oxytet. What's the next argument, it only went out of date in July, it will be fine?

I agree we need pressure on drug companies to make smaller volumes/single dose bottles. I don't believe the solution is relaxation of the 28 day rule or allowing use of human generics.

RE: Can I have the rest of the bottle?

bob lehner — Sat, 22 Sep 2018 21:16:56 GMT

[quote user="Neil Wheadon"]If another vet came and took it for a case, he was told' then he could be remunerated, because that folks is why he wants it.[/quote]

In the rather unlikely event that you found another case to use the stuff within the 28 day broaching period then it would be reasonable to refund the first client 50% and charge the second client 50% of the whole bottle price.

It's not going to happen tho' is it....?

RE: Can I have the rest of the bottle?

Anthony Todd — Sat, 22 Sep 2018 16:27:04 GMT

Michael, why do you disagree? I know it's "the law" just that the law is untested and therefore illogical, and based on no facts.

I accept that blood alcohol and speed limits are sensible but there's no sense at all in the "broach dates" etc, just a copy and paste from human single use packaging.

RE: Can I have the rest of the bottle?

Anthony Todd — Sat, 22 Sep 2018 15:56:22 GMT

[quote user="Neil Wheadon"]OK there is 94ml of Imazol here[/quote]

And, of course, and as well, there's absolutely no evidence that it is not effective for the next 94 months, or more, or less, just a law saying it isn't.

In this age of added regulation and oversight doesn't anyone accept that the "broached date and discharge" is an embarrassment to any scientist, or even someone with just common sense?

RE: Can I have the rest of the bottle?

Neil Wheadon — Sat, 22 Sep 2018 15:16:54 GMT

OK there is 94ml of Imazol here. I'm locumming and that may get everyone out of feeling uncomfortable about this. (the client as he's paid a lot - justifiably charged, and myself because I almost feel mean, but the comments here are far to persuasive)

So PM me if you have a case of Babesia and need it

Neil

RE: Can I have the rest of the bottle?

Matt Hilary — Sat, 22 Sep 2018 15:01:27 GMT

[quote user="Neil Wheadon"]

If another vet came and took it for a case, he was told' then he could be remunerated, because that folks is why he wants it.

[/quote]

If the rationale behind charging for a whole bottle is that it is highly unlikely to be used again within 28d I'd be quite happy to split the cost of the bottle between 2 clients equally and refund accordingly (though would still charge initially as normal).

RE: Can I have the rest of the bottle?

Neil Wheadon — Sat, 22 Sep 2018 14:30:23 GMT

If another vet came and took it for a case, he was told' then he could be remunerated, because that folks is why he wants it.

Would that be an option?

Neil

RE: Can I have the rest of the bottle?

Clare Tapsfield-Wright — Sat, 22 Sep 2018 13:56:51 GMT

I wouldn’t give him the rest ofthe bottle , he’s going to use it when out of date or inappropriately or flog it. Tell him it will be labelled with his name and stored for 28 days then destroyed unless he presents another animal that needs some.

RE: Can I have the rest of the bottle?

Michael Woodhouse — Sat, 22 Sep 2018 13:49:30 GMT

Sorry I wouldn't give bottle to a dog owner. Assumed this was for a farmer and a cow

RE: Can I have the rest of the bottle?

Stephen Courtney — Sat, 22 Sep 2018 13:10:43 GMT

Dogs going to China need to have 2 doses 'just in case' I believe

Definitely would NOT give the client the bottle. You wouldn't give them antibiotic or steroid or alizin would you?

It is really toxic stuff, and what on earth would they want it for?

If they just want to make sure you don't resell the remainder, I would allow them to watch me destroy the drug eg inject disinfectant into the bottle, then place the bottle in DOOP, but that would also be my last dealings with that person.

RE: Can I have the rest of the bottle?

Neil Wheadon — Sat, 22 Sep 2018 12:43:43 GMT

[quote user="bob lehner"]6 mls seems a big dose [/quote]

3.1 ml a time

Thanks Bob and everyone.

Neil

RE: Can I have the rest of the bottle?

bob lehner — Sat, 22 Sep 2018 11:59:40 GMT

I don't think I would hand over the bottle.

Reading the data sheet there are some fairly dire warnings re possible side effects and potential harm to the operator. It is not licensed for use in dogs - so clearly a cascade decision was made.

The recommendation for dogs (BSAVA Formulary) is 1 injection at 6.6 mg/kg im/sc, and repeat in 2-3 weeks. 6 mls seems a big dose - or did that include the second shot? I would get him to come back for the second dose as appropriate.

The product has a 28 day discard after broaching - so of no legal use to anyone after that.

As Martin says above the reasons for the owner wanting the rest of the bottle are not obviously compatible with your duty as the prescriber.

RE: Can I have the rest of the bottle?

Martin Atkinson — Sat, 22 Sep 2018 11:07:30 GMT

I wouldn't give them the bottle unless there is valid reason i.e. the dog needs another injection in less than 28 days, you are confident the owner is competent to make the right decision on when and how to inject it and has facilities to dispose of it safely. I presume he was told the cost of the injection which included the whole bottle and accepted this so that is just the charge end of. He can have no argument with that, you now have responsibility to dispose of the remainder. The compromise would be that if it needs another injection in less that 28 days you will give it for free.

The legal basis IMO is it seems obvious he wants to keep the bottle for future use either on this animal for another dose or another animal which is not immediately under your care and as you have not prescribed it for that usage I feel you are legally obliged to refuse.

Frankly he sounds like the kind of client I wouldn't want anyway but it would be interesting to know the history of how this dog caught Babesiosis and how it was diagnosed.

RE: Can I have the rest of the bottle?

Bob Russell — Sat, 22 Sep 2018 10:58:58 GMT

I would supply the bottle suitably labelled but on the condition that it is stored correctly and that a diagnosis is made before further doses are administered. In this case it might be after a telephone discussion.

Farmers are legally required to keep records of medicine use therefore misuse should be identifiable.

If you do not have sufficient trust in this client, keep the bottle for the period allowed on his/her behalf. They have paid for the bottle. This is the only option (other than charging per ml) for medicines you do not feel should be left on the farm premises.

Never happened in our small animal practice but if someone pays for a full bottle of Alizin for example, I would label it and keep it for them or offer a partial refund in the unlikely event someone else needed the same stuff!

RE: Can I have the rest of the bottle?

Michael Woodhouse — Sat, 22 Sep 2018 10:40:08 GMT

I'd have let them have the bottle. The "the manufacturer does not supply that veterinary medicinal product in a smaller container;" I think covers my back. So long as he knows he shouldn't use it after the 28 days are up. Chances are babesia is not an indivudual animal condition.

RE: Can I have the rest of the bottle?

Clive Ansell — Sat, 22 Sep 2018 10:38:23 GMT

[quote user="Neil Wheadon"]

A clinic uses a drug for a dog that is ordered especially. As many practices do they charge the whole amount as the rest of the bottle is going to be thrown away.

The client simply asked 'I want the rest' and is quite insistent.

Can a vet refuse? Is there any legal basis?

[/quote]

Can, and should refuse. It is a POM-V and you have prescribed 6.0ml. If you haven't prescribed the remaining 94ml, the client has no right to it - end of. The fact they pay for the whole bottle is a consequence of the rules whereby we have to dispose after 28 days. Are they charged for disposal?

In the case of Imizol, it is a single injection only. What would a client do with the remainder? have they got the correct facilities for safe storage and disposal?

From the data sheet, looks like pretty nasty stuff to have around.

RE: Can I have the rest of the bottle?

Neil Wheadon — Sat, 22 Sep 2018 09:57:50 GMT

[quote user="Michael Woodhouse"]What is the drug?[/quote]

Imizol - 100ml bottle for Babesia

Used 6ml

I'm going to call the VMD on Monday as Robloxey comments make me uneasy.

Neil

RE: Can I have the rest of the bottle?

Rob Loxley — Sat, 22 Sep 2018 08:33:45 GMT

[quote user="Neil Wheadon"]Can a vet refuse? Is there any legal basis?[/quote]

VMR says

"Duties when a product is prescribed or supplied

7. A person who prescribes a product classified as POM-V or POM-VPS, or supplies a product classified as NFA-VPS—

(a)before doing so, must be satisfied that the person who will use the product is competent to do so safely, and intends to use it for a purpose for which it is authorised;

(b)when doing so, must advise on its safe administration and on any warnings or contra-indications on the label or package leaflet; and

(c)must not prescribe (or, in the case of a NFA-VPS product, supply) more than the minimum amount required for the treatment; but it is a defence to a charge of failing to comply with this paragraph to show that—

(i)the product prescribed or supplied was in a container specified in the marketing authorisation;

(ii)the manufacturer does not supply that veterinary medicinal product in a smaller container; and

(iii)the person prescribing or supplying is not a person authorised to break open the package before supply"

I think the relevant bits are competency of the client to use it, particularly if it is an injection (which I assume), and the bit about only supplying the minimum amount required for treatment.