Do clients have to pay OOH in the event of a post op complication?

RE: Do clients have to pay OOH in the event of a post op complication?

Martin Atkinson — Thu, 10 Dec 2015 15:50:33 GMT

[quote user="Braden Collins"] They're paying for the treatment as we made it very clear, and even gave the instructions in writing.[/quote]I do try to remember to give every client a discharge letter emphasising the need to keep on E collars and not allow their animals to interfere with dressings. Unfortunately the idiots who are most likely let them do so are often the charity neuterings who couldn't afford to pay for the op in the first place so can't afford the treatment for the complications and as likely to transfer the blame to me and insinuate it was my (lack of) surgical skills that caused the problem.

RE: Do clients have to pay OOH in the event of a post op complication?

Anthony Dennison — Thu, 10 Dec 2015 13:29:33 GMT

The other week the vet who I was back-up to had a call about a dog that had had an operation earlier in the day. Dog was now whining and not settling (just as it had done after a GA a year or so ago). Owner was worried and wanted the dog admitted and monitored. Owner was charged OOH fee and hospitalisation, as the dog was fine, not painful and was just feeling the after effects of a GA.

Not a surgical complication, just a neurotic owner. I personally felt if the owner wanted our service rather than just letting the dog settle instead of staring at it all night, she should be charged.

RE: Do clients have to pay OOH in the event of a post op complication?

Braden Collins — Thu, 10 Dec 2015 12:56:45 GMT

We share our OOH with another clinic and have an agreement that we treat any post-op complications as though the client was our own.

As for who pays, it depends. A slipped ligature from a spey would be at our cost, where as a dog opening up it's suture line (all go home with e-collars) will be the client paying. I'm in the process of treating a dog which had a toe amputation, which them amputated 2 more toes itself when the owner took the collar off against our advice. They're paying for the treatment as we made it very clear, and even gave the instructions in writing.

RE: Do clients have to pay OOH in the event of a post op complication?

Bob Russell — Thu, 10 Dec 2015 12:47:17 GMT

[quote user="Martin Atkinson"]

Fortunately I cannot remember a single occasion when a client of mine has had to go to an OOH clinic due to a post-op complication. Whether this is due to my supreme skill or just good fortune I'll leave you all to decide but I would expect the client to pay the OOH provider and then complain to me when I would judge whether I should reimburse them.

[/quote]

I have to say this is the first time in years this has happened and generally I would accept the blame and sort it out, FOC or cost of drugs etc. £600 per inch is crackers IMO.

RE: Do clients have to pay OOH in the event of a post op complication?

Martin Atkinson — Thu, 10 Dec 2015 11:27:48 GMT

[quote user="Gillian Mostyn"]

The 'compassion burn out' thread, in which you said:

I am sole charge, work 11-12 hours every weekday and Saturday mornings, and until recently did all my own out of hours.

[/quote]I guess the key words are 'until recently'. The last 7-8 years out of a career of 41 is fairly recent to me but it still means I don't do it anymore. It is recent enough for me to still go bed at night with the feeling of relief that I know I won't be called out for anything else than to go and rescue one of daughters when they've missed the last train!! That said I'm am on call tomorrow because the OOH clinic can't cover me.

[quote user="Gillian Mostyn"]As far as never having has one of your ops become an overnight complication for someone else - that's impressive. I've never had a serious complication (that I know of) but plenty of minor hiccups.[/quote]Given patients wouldn't be sent home without being fit to do so and will be booked a post op check in 48 hours there shouldn't be a lot to go wrong in between or after. I would be lying if I said I've never had a post op complication that had to be dealt with OOH but the handful which have have fallen on my watch.

RE: Do clients have to pay OOH in the event of a post op complication?

Ashley Rubens — Thu, 10 Dec 2015 00:09:04 GMT

We tend to go with a sliding scale of clients fault (eg not following advice) they pay full fee, our "fault" (ligature slip) we pay, with quite a few going into a middle ground of client paying somewhere between full price and cost where it's disputeable or just bad luck.

I worked in a Vers now clinic who covered a one-woman-band who would have atleast one bitch spay a week present bleeding out, clients always paid full cost to us, we weren't allowed to comment on other cases or anything other than it being a recognised complication, and she had a fantastic surgical reputation locally due to making extremely small holes in things so afaik never had to issue a refund - it's all in the chat sometimes!

RE: Do clients have to pay OOH in the event of a post op complication?

grumpyoldman — Wed, 09 Dec 2015 23:34:07 GMT

We have always done our own OOH , left it to the vets discretion and individual circumstances but usually it looks at though the insured probably get charged a lot more than the uninsured which probably is manifestly unfair on those delightful creatures the insurers, but that probably also applies to check ups follow ups etc.

A routine elective surgery would not get charged anything , although I do remember one of my early bosses telling me that "if you re-suture it for nothing once you could end up doing it half a dozen times ,but if you charge them for it you will only do it once". Time and experience proved him right most of the time ,once its out of the door you have no control and so responsibility should fall on the owners.

RE: Do clients have to pay OOH in the event of a post op complication?

bob lehner — Wed, 09 Dec 2015 20:36:12 GMT

[quote user="Clive Ansell"][quote user="Clive Ansell"][quote user="Kate Richardson"]Difficult situation re post op problems, do all clients get charged full OOH fees by OOH clinics if its a genuine post op problem? As we do our own OOH, we would use our discretion re fees, depending on the problem[/quote][/quote][/quote]

These tricky situations are always going to crop up from time to time in the real world.

Best to have a plan in place before the event.

For OOH clinics which are accredited as ESCs under PSS 'a written agreement must be entered into with the client practices which includes a written policy on surgical complications of their cases'.

RE: Do clients have to pay OOH in the event of a post op complication?

Gillian Mostyn — Wed, 09 Dec 2015 19:56:13 GMT

[quote user="Martin Atkinson"]I'm not sure which stick you've got the wrong end of here Gillian. I haven't done my own OOH for 8 years [/quote]

The 'compassion burn out' thread, in which you said:

I am sole charge, work 11-12 hours every weekday and Saturday mornings, and until recently did all my own out of hours.

And you went on to discuss at length that OOH isn't stressful or a barrier to a full social life! My argument in that thread was that when I did OOH (up to 6 years ago - I don't consider that recent as it fortunately feels like a LONG time ago!) it wasn't as stressful as now - client expectations and sense of entitlement has changed recently.

Anyway, I've gone off on a tangent. Sorry.

As far as never having has one of your ops become an overnight complication for someone else - that's impressive. I've never had a serious complication (that I know of) but plenty of minor hiccups.

RE: Do clients have to pay OOH in the event of a post op complication?

Martin Atkinson — Wed, 09 Dec 2015 19:00:48 GMT

[quote user="Gillian Mostyn"]Which is it - OOH provider or 24/7 sole charge????[/quote]I'm not sure which stick you've got the wrong end of here Gillian. I haven't done my own OOH for 8 years but before that I worked 24/7/52 apart from a brief spell when I shared a rota with other practices which was worse than being on 24/7/52 for myself and occasionally have helped local practices out by taking their calls when they have been stuck.

RE: Do clients have to pay OOH in the event of a post op complication?

Gillian Mostyn — Wed, 09 Dec 2015 18:08:39 GMT

[quote user="Martin Atkinson"]Fortunately I cannot remember a single occasion when a client of mine has had to go to an OOH clinic due to a post-op complication. Whether this is due to my supreme skill or just good fortune I'll leave you all to decide[/quote]

Hang on Martin - in other threads you have discussed at length how you've done your own OOH, and therefore worked 24/7/52, for years and how it didn't interfere at all with your quality of life, or your cycling!

Which is it - OOH provider or 24/7 sole charge????

RE: Do clients have to pay OOH in the event of a post op complication?

Martin Atkinson — Wed, 09 Dec 2015 17:16:21 GMT

[quote user="Clive Ansell"]original spay £90, bill from RVC for ga/ivft/abd lavage/re suture was £1200. Most members of Joe public are surely going to question the ethics of an original op at £90, but £1200 to re suture ??[/quote]That is what we have VDS insurance for. I would not personally reimburse the client for that, I would advise them to sue me.

RE: Do clients have to pay OOH in the event of a post op complication?

Martin Atkinson — Wed, 09 Dec 2015 17:12:24 GMT

RE: Do clients have to pay OOH in the event of a post op complication?

Clive Ansell — Wed, 09 Dec 2015 17:06:01 GMT

[quote user="Bob Russell"]£600 for domitor/vetergestic premed, propofol and the works. 4 hours 'unstable' in patient charge. Blood donation charge etc etc. History suggested a complete drama, but the re-sutured wound was still about 1" long![/quote]

If not possible to staple with a splash of local. it could have been bounced back to the user practice for suturing the next day?

RE: Do clients have to pay OOH in the event of a post op complication?

Bob Russell — Wed, 09 Dec 2015 17:05:35 GMT

Dead cheap if you work it out per inch of wound. Assuming a neat and smallish wound of three inches it is only £400 per inch.

RE: Do clients have to pay OOH in the event of a post op complication?

Michael Woodhouse — Wed, 09 Dec 2015 17:05:03 GMT

A small wound breakdown does not need doing OOH.

I agree with the view that if we were in any way at fault then no OOH charge, but if owner didn't follow instructions, or genuine risk from op (even a wound breakdown) or just being fussy (1 drop of serum) then would charge full fees.

RE: Do clients have to pay OOH in the event of a post op complication?

Clive Ansell — Wed, 09 Dec 2015 17:03:11 GMT

I came across a case about 3 years ago, where a bitch spay midline wound opened up completely with evisceration of omentum and bowel. Given it was a Sunday morning it ended up at the RVC OOH department. uneventful recover.

original spay £90, bill from RVC for ga/ivft/abd lavage/re suture was £1200. Most members of Joe public are surely going to question the ethics of an original op at £90, but £1200 to re suture ??

RE: Do clients have to pay OOH in the event of a post op complication?

Hannah Wynne Richards — Wed, 09 Dec 2015 17:02:18 GMT

Advantage of doing my own ooh. I don't (touch wood) get many post-op complications, but if 1 occurs, I just tell them to come in, and sort it out without needing to involve another practice

Wynne

RE: Do clients have to pay OOH in the event of a post op complication?

Bob Russell — Wed, 09 Dec 2015 17:00:07 GMT

Worth a bit of 'turbo' posting!

This was a one off and generally I had been impressed with the OOH service offered around here but this was really extreme and did nothing for my reputation or the OOH's service.

RE: Do clients have to pay OOH in the event of a post op complication?

Bob Russell — Wed, 09 Dec 2015 16:53:00 GMT

One of my patients was spayed and a small subcutaneous lump removed. The wound in the shoulder, opened up, part owner, part patient and a small part my responsibility as we clearly did not 'educate' the clients enough.

£600 for domitor/vetergestic premed, propofol and the works. 4 hours 'unstable' in patient charge. Blood donation charge etc etc. History suggested a complete drama, but the re-sutured wound was still about 1" long!

When questioned, I received a full breakdown of what was charged. It could have been stapled, it could have been done with a reasonable level of sedation (or none if being mean!). If I had been faced with a bill for this complication by my out of hours provider, I would have been a hell of a lot less impressed than the owner was! They were pi**ed off enough with the size of the bill and this was an insured dog!

RE: Do clients have to pay OOH in the event of a post op complication?

Virginia Campbell — Wed, 09 Dec 2015 16:41:36 GMT

Our local Vets Now do consult + place a few staples FOC in the occasional one that has popped a couple of sutures. We are fortunate in that nothing has - touchwood - come horribly unzipped at home so far. We are lucky in that we have an overnight nurse who can monitor cases that we consider higher risk for complications so we keep those overnight ourselves.

RE: Do clients have to pay OOH if a genuine complication?

Clive Ansell — Wed, 09 Dec 2015 16:31:23 GMT

Genuine is poor choice of word I suppose, acceptable complication may be better?

In all of my regular practices we would reimburse the client if the fault lay with the vet or the practice; haemorrhaging bitch spay through poor ligatures, practice would pay. If a wound came apart because owner removed buster collar, then client would pay. Many grey areas though I know.

RE: Do clients have to pay OOH if a genuine complication?

Malcolm Ness — Wed, 09 Dec 2015 16:25:10 GMT

What makes a complication "genuine"?