What can veterinary team members do when a pet owner's behavior crosses a line?

Q. I just read “Commentary: Veterinarians need better boundaries." I strongly agree with this article. I wanted to share with you a situation I am personally dealing with. I am the hospital administrator of a large practice in Dallas, Texas. Recently, I received notice of an investigation the state veterinary board has filed against me for “firing” a client. I'm concerned about this article saying we should “empower staff to fire clients” when our state board is not supportive of veterinarians allowing this to happen.

Insights from dvm360 contributor Marc Rosenberg, VMD:

The commentary in question certainly has merit. It describes a situation in which a veterinarian was pushed too far by an out-of-control client. Emotions took over, a confrontation resulted, and the client was “fired.” In order to avoid state board sanctions, in cases such as these where the client feels they were mistreated, maintaining professionalism is the key.

I personally feel that firing a client should be avoided at all costs. This does not mean that a private practice veterinarian does not have this option under extreme circumstances. A veterinarian or administrator, while maintaining a professional demeanor, can inform a client that the pet can no longer be treated at the facility. The doctor then offers to give the pet owner a copy of the medical records and the contact information for referral options of area veterinarians who can provide continuing care. The doctor should also offer to consult with the new veterinarian if it is deemed necessary.

The only exception to this protocol would be if the pet was being treated as an emergency. In this case the animal must be stabilized before clinic care is terminated. The veterinarian must consider the health and welfare of the pet patient the priority.

As long as the doctor adheres to this protocol and maintains a professional demeanor, no reasonable state board will mandate a sanction for terminating a client for cause.

And what's the DVM lawyer say ... ?

Insights from dvm360 contributor Christopher Allen, DVM, JD:

This commentary and the reader's response both present interesting angles on the issue of “empowering” non-DVM staff members to “fire” a veterinary clinic client when such a client displays patently improper behavior. I would offer, with respect to both contributors' input, both an observation and a recommendation.

First, we need to recognize the reality of potentially conflicting regulatory objectives in situations where non-DVM team members are allowed to “fire” clients. On the one hand, state regulators are charged with protecting employees in the workplace. We know that unstable members of the public, and even employees, have many times acted out in contentious situations at businesses in the past. (Remember the reason we sometimes refer to outrageous expressions of frustration in the workplace as “going postal.”) Government agencies charged with protecting our staff members run the gamut from OSHA to state workers' compensation boards-these folks don't want your receptionist in danger or abused in any way while carrying out her job.

On the other hand, state veterinary boards are charged with protecting the public from behavior of veterinary team members and veterinarians that may endanger animal health and safety. The boards are empowered to look not only at veterinarians' qualifications and behavior, but also what veterinary team members are allowed to do.

The original commentary writer has identified a situation where these two government objectives are at cross purposes. Government agencies and state boards want animal hospitals to keep their staff safe from potential physical and emotional injury, while at the same time maintaining a professional level of care for animals. As is so often the case, it's up to the doctor in charge to satisfy both bureaucracies.

I feel that the final legal responsibility for refusing service to an existing client is that of a staff DVM.

I feel that the final legal responsibility for refusing service to an existing client is that of a staff DVM. Most practice owners wouldn't want a relief doctor to make the decision to do it, and they probably shouldn't let a non-DVM staff member do it. Here's why.

'You wouldn't walk out of surgery mid-splenectomy'

Refusing to continue professional service to a member of the public is a big deal. For example, lawyers aren't allowed to unilaterally “fire” a client during litigation, as it could severely damage the fired client's case as it moves forward. That's why a judge generally must approve attorneys' removing themselves from a pending case.

The same applies to veterinarians and physicians. You wouldn't walk out of surgery mid-splenectomy if you heard the veterinary client giving your receptionist a hard time. You'd finish the procedure, review the circumstances of the argument and decide whether it's safe and appropriate to discharge the patient and thereafter refuse further business with the pet owner.

While that surgical example is the extreme, look at the general concept of allowing non-DVM staff to “fire” a client. The state veterinary board might ask, “How do we know that the veterinary staff member has considered the health and ongoing treatment plan for the animals belonging to the obnoxious pet owner?” and “Are the front staff qualified to decide whether a doctor needs to be involved with helping this impossible client obtain qualified specialty care after the ‘firing'?”

A veterinary board investigator has no way to know whether the patient's medical needs are being taken into due consideration when a staff member “fires” a client.

A veterinary board investigator has no way to know whether the patient's medical needs are being taken into due consideration when a staff member “fires” a client. The agency just knows that there has been an allegation that a nondoctor withdrew a clinic's care from a member of the public-whose interests the agency is bound to protect.

Advice for managing bad client behavior

So, here's my suggestion as to how to proceed when a client behaves inappropriately:

• The offended staff member(s) may tell the veterinary client that the behavior will not be tolerated at the hospital.
• The staff member or practice manager gathers a written narrative of the encounter from staff members who witnessed it.
• The staff member or practice manager provides details to the doctor who was on duty and to the practice owner.
• The veterinarian with decision-making authority notes in the patient's record the current medical status and forward-looking treatment strategy for all of the offending client's animals.
• If the decision-making veterinarian elects to discharge the client, they should do it as diplomatically as possible first by phone, then in writing sent certified mail with return receipt requested.

I would also recommend explaining to the client that your hospital will continue to offer services for a period-say two weeks-but only in the event of a genuine veterinary emergency.