ComplaintsforRussell Lake Animal Hospital

• Initial Complaint

  03/03/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I took my cat for emergent care due to an illness that has been now identified as chronic (as the exact same thing was diagnosed last year) upon arrival I signed a document acknowledging the exam fee and also specifies how much Im willing to spend before they have to ask to proceed with additional care. I put $250 max. When I picked up my cat the bill was $315 and I was never informed of the price going above what I was authorized. I explained to the front desk person and she put me on the phone with the doctor who tried to tell me she did ask me--I confirmed she did not. Then she said "well thats why I called" and I said no you called to tell me whats wrong with my cat because I cant be there due to your covid protocols. She said "she assumed that I knew because she specified what was wrong that I knew it would cost more" I asked how that was possible since there is no where to tell how much any of the charges were? She said "well we're not allowed to post those..." I then explained that I was not looking for anything but validation that they made an error since they never informed me of the additonal cost. She then said "yes I suppose your right we need to be more clear over the phone" and I added "..and honor the legally binding document the customer signs???" And she agreed. Last year my bill for the same diagnosis (including $60 worth of food) was $230.54. This appointment did not include food and it was $315.89.

  

  Business response

  05/03/2022

  Re: BBB Complaint ID of 16831835
  
  Dear Sir,
  
  Thank you for the opportunity to respond to this complaint and try to clear up some misunderstandings. 
  Jupiter has a condition called Feline Lower Urinary Tract Disease. This condition may cause him to have bladder related symptoms on and off for the rest of his life. However, the symptoms may vary from episode to episode and will require different treatment each time based on examination and testing. Because this condition is usually accompanied with pain and inflammation, male cats are at a high risk of developing a urethral blockage which is a life threatening condition. For this reason, when male cats start to exhibit these symptoms we recommend not delaying any treatment or care. 

  When Jupiter’s owner (***** ******) called to express concerns about his condition we recommended bringing him as soon as possible and we fit him into an already full day of work.
  Last year Jupiter’s urine urinalysis revealed minimal red blood cells in the urine, a small number of epithelial cells (the cells that line the bladder walls) and no crystals.

  This time Jupiter exhibited significant hematuria (blood in urine), moderate amount of epithelial cells and a few crystals. I have copied the two results for comparison below and added comments in brackets.

  
  UA Analyzer (March 23, 2021 2:12 PM)
  Collection Cystocentesis
  Color Pale Yellow
  Clarity Clear
  Specific Gravity > 1.050
  pH 7.0 (abnormal acidity)
  PRO 1+
  GLU Negative
  KET Negative
  UBG 2+
  BIL Negative
  BLD 1+ (minimal red blood cells) 
  WBC <1 /HPF (minimal white blood cells)
  RBC 17 /HPF (minimal red blood cells)
  Bacteria
  Rods None detected
  Cocci None detected
  EPI (epithelial cells)
  Squamous None detected
  Non-squamous <1 /HPF
  Casts
  Hyaline None detected
  Non-hyaline None detected
  Crystals
  Unclassified None detected
  CaOx Di None detected
  Struvite None detected
  Amm Biurate None detected
  Bilirubin None detected
  
  UA Analyzer (March 3, 2022 3:33 PM)
  Collection Nosorb
  Color Red Pale
  Clarity Cloudy 
  Specific Gravity > 1.050 
  pH 6.5 (normal acidity)
  PRO 3+ (High)
  GLU Negative 
  KET Negative 
  UBG Normal
  BIL Negative
  BLD 4+ (Very high red blood cells count)
  WBC 7 /HPF
  RBC >50 /HPF (Very high red blood cells count)
  Bacteria
  Rods None detected
  Cocci None detected
  EPI
  Squamous None detected
  Non-squamous 3 - 5 /HPF
  Casts
  Hyaline >1 /LPF
  Non-hyaline None detected
  Crystals
  Unclassified <1 /HPF
  CaOx Di None detected
  Struvite <1 /HPF
  Amm Biurate None detected
  Bilirubin None detected
  ***** signed our curbside consent. This form indicates that today’s visit will incur a charge of $98.09 +tax which is the exam fee.
  
  In addition, we ask the owners if they will authorize additional treatments or procedures and up to what cost prior to taxation:
  As per Sarah’s signature she has authorized $250 before tax for any additional procedures (in addition to the examination) if we are unable to reach her.  

  
  When I called ***** to inform her that Jupiter did not have a urethral blockage but will need a urinalysis nonetheless, I did neglect to inform ***** of the cost of the urinalysis (which is $104.70 + tax (this number is also on the invoice submitted by ***** for line item Urinalysis, single sample) but at the time I didn’t think much of it since it was within the amount that ***** indicated she was comfortable with. 

  
  Once we have determined what is the best medical treatment for Jupiter, I called ***** to update her and let her know the results of the urinalysis and explain the medications planned for the treatment. Again, I should have advised ***** of the cost of these medications but since it was still within the indicated amount and since owners have the right to refuse to take products if they feel they do not agree with the treatment plan, I did not think much of it. 
  ***** signed a form indicating she is authorizing us to treat Jupiter at the total cost of $400.30 ($98.09+$250=$348.09 +15% tax). 
  The total cost of her treatments was $274.69 +15% = $315.89
  
  Jupiter received a longer course of medications this time since his condition was more serious therefore the cost of his treatment is higher this time around. In addition, the price of our services has gone up significantly since last year due to our increased costs of operations and our increased payroll costs as we strive to help our staff deal with the increased costs in their day to day lives as well.
  
  Both the physical exam and urinalysis were absolutely necessary in order to treat Jupiter. Declining any of them would have meant that Jupiter would have had to go home without medications since treating this condition without examination or urinalysis would be considered below standard of care on our part. 
  As ***** has stated, I did acknowledge that I should have given her the costs of the tests and medications prior to her coming to pick up Jupiter. I did apologize for this oversight and will do my best to make sure we have more clear communications with our clients.

  I hope this clears up the misunderstanding. 

  If there are any additional questions or concerns I will be happy to answer them.

  Best regards
  **** ****** DVM MSc
  
  Tell us why here...

  Customer response

  09/03/2022

   I am rejecting this response because:
  
  
   I am rejecting this response because:
  
  
  Although the explination is very detailed in their response--it took me taking this experience to the BBB to be provided an explination into my pets health. In the conversation with the Doctor it was MYSELF that had to pose the question of "is this classified as now a chronic condition?" to which I got the Answer of "Yes" and nothing more. No name or explination of the condition or potential impacts for the future of my cats health. Although I appretiate the detailed breakdown of cost, the contract I signed, to my knowledge on reading did not acknowledge that the amount I was agreeing too did not included tax, or the cost of the assesment. I had the contract thrust at me in the doorway of the clinic in the middle of a snowstorm and it was clear that their was a rush *which the Doctor identified as they were fully booked--but then insinuated that they although booked they were gracious enough to take him in--when in actuality if they are too busy to take an animal for care I see it as a disservice and frankly unprofessional to the client as it cannot be guarenteed that the same level of care would be provided due to the PRESSURE of being over booked. I also only received the total of services over the phone and not the explination of what the services provided were, then was immidiately asked for what credit card to pay with; essentially being pressured to pay before I even know what I am paying for. I stopped the receptionist and I did ask the receptionist to provide breakdown of charges, she was not able to respond and that is how I was connected to the vet in the first place. I never received the break down over the phone beyond the urinalysis which again, was not specified as being a charge beyond what I agreed too based on my knowledge of the agreement I felt pressured to sign and was given no opportunity to read effectively. I would also like to acknowledge the gross level of abilism to assume so much of a client to not only read and process information while being rushed, but to retain it while rushed and in an emoution state due to the fear for their pet and furthern too assume the person signing the contract UNDERSTANDS what they are signing. Not receiving a copy of the contract is also problem as it leaves no opportunity for the client to have quantifying evidence of the agreement or be able to ask questions. It is also abilist to assume that everyone can pay by credit card. I indicated I would prefer by debit but that was not acknowledged, and was asked "what kind of credit card I would be paying with" Legal tender is legal tender; refusing a method of payment is not legal nor is it good business practice. It also sets the tone that you need to be a spicific "type of person who has credit access" to have services rendered and creates stigma to those clients who dont have credit access. The Doctor stated in response to my complaint that due to the illness my cat has it will reqire different levels of intervention dependant on individual flair up, and that as my cat was "more sick this time, then the previous time and received more medication as a result which attributes to additional cost" I would like some understanding that if this is the case; why did I receive only 6 anti-inflammatory pills this visit where as the previous I received 7? Additionally I was never given the option to fill the perscription myself, which upon doing some research-is not only within my right to do so but also much more reasonable price wise then getting the medication from the vet. Their explination of price increases also raises some questions as my understanding is that when in a state of emergency, it is illegal to raise prices on essential services, and the Nova Scotia Government Emergency Act has infact deemed Vetinary service as an essential services? By way of comparison in my bills from last year to this one, combined with the Vets detailed reasoning behind the rise in cost lends that this clinic is actually breaking the law and this is price gouging. Below is an artical to support my findings. https://www.google.com/amp/s/www.cbc.ca/amp/1.5510884 Also in accordance with the Nova Scotia Vetinary Council Bylaws: 13. It is unprofessional for a member to breach or fail to comply with any condition, restriction, or direction imposed upon the member by Council. So I am wondering if this should be brought to the Committee's attention for purposes of violating Ethics mandates? (As well of course the government) I am also wishing to have clarification as too What regulatory body has dictated that prices are not allowed to be known to a client until *in this case AFTER* service provided? It was asserted to me by the Vet I spoke too that its not allowed across the industry to have prices visble? When in fact that is wrong in accordance with the NSVC: The context in which prices cannot be displayed is in regards to advertising to attract clientel, and not to inform clients of cost for service. As below directly from the Ethics document provided by the Nova Scotia Vetinary Code of Conduct: 36. (a) In this section “marketing activity” includes: i) an advertisement, which is defined as the use of paid space or time, in a public medium, or the use of a commercial publication such as a brochure or handbill, to communicate with the general public or a segment thereof, for the purpose of promoting a member’s professional services or goods or enhancing the image of the member; ii) any publication in any medium or any communication with the public, or with any client or prospective client in the nature of an advertisement, promotional material, a listing in a directory, a public appearance or any other means by which veterinary services are promoted; and iii) contact with a prospective client initiated by a member in a manner which can fairly be regarded as directly or indirectly having for its purpose attracting clients, expanding services, or aggrandizing that member’s professional reputation. If they are using the increase of prices as the explination behind the bill increase (which again is currently illigal) HOW can the increase on each service be varified if the client has no access to cost of any service beyond the innitial exam? The whole reason why I have brought this complaint to BBB is: -To have my questions answered -To have the company held responsible for actions -To hop the vet establishment will do better to undestand the need of training on how to provide trauma informed service; as this sort of practice is not only conviluted, but a detriment too those who lack the skills necessary to convay the communication necessary to receive answers like this, or even know where to ask them; and also because price gouging in our current economy is just wrong They are dealing with people who are experiencing disregulation emotionally as they are distressed about their pet. -Too address The Vet establishment making a post on facebook vying for empathy as lately they have experienced increased instances of clients being upset, and reacting to staff in an unsavory way (they labled as abuse) when they neglected to question WHAT (beyond Covid measures) the clients (WHO ARE PROVIDING THEIR INCOME) are actually trying to communicate? If the people you are talking about experienced the lack of accountability and professionalism that I did--no wonder they expressed their frustration (not that I condone mistreatment of any kind) but the bottom line is tolerence for abuse goes both ways. And Verbal abuse also includes a few things I experienced FROM a staff member on staff at Russell lake: minipulation, gaslighting and invalidation (which only became validated when I spicifically asked to be) too name a few. If announcing on facebook your tolerance policy; and not even following your own; it is unethical practice and is putting a problem on the client that is stemmed from the companies lack of managment skills and professional development. I can absolutely say without a single doubt in my mind that their are ALWAYS 2 sides to every story, and its clear only one side is being highlighted. -To raise awareness of misdeeds companies like this feel entiteld to get away with, and assume they wont be called ou. My job professionally is in advocacy, and social justice. The establishment is servicing the community but not actually taking the community into account, nor are they validating that they wouldent be a company without their clients. I am greatful and recognize my priviledge to be able to afford vet care, but many people are not but are willing to put themselves into massive debt to save the life of their companion when, in this case, it beging done illigally. Based on the respose I received I am going to confirm that this meets the criteria of a company who is; -BREAKING THE LAW. -NOT taking accountability for their actions beyond "I will try to do better" and "trying" is subjective; You are not asking for forgiveness, you are asking for absolution from wrong-doing. -Intentionally withholding information unless the client is incredibly spicific on what they need (or report them to a regulstory body for bad buisness practice) or giving misinformation to the client that its industry standard not to have pricing information;w which supports the company to continue to overcharge. All of THIS I do not expect from a place that is suppose to be compassionate, understanding and ultimately responsible for saving what some people see as theyre own "children". So please, help me understand how this situation will be addressed further?

  

  Business response

  10/03/2022

  Dear sir,
  This is the answer ***** Eyland’s (Client) 2nd comment on this complaint: 
  

  1. Jupiter's last visit is the second time the client has brought him in for this condition: Inflammatory cystitis. The name, nature and prognosis has been explained once already in June of 2021, including the role of a prescription diet to aid in prevention or reduction of flair ups in this condition. The issue was discussed with the client once more after admission when obtaining consent for the urinalysis, in which the client expressed her familiarity both with the condition and the testing required since they were discussed with her previously. The condition, test findings, treatment and follow up was explained again to the client when I called to relay the results of the urinalysis. At many intervals during these calls the client was asked if she had any further questions. 
  

  2. The consent form clearly identifies the exam fee ($98.09 + tax) and is highlighted in yellow to ensure people pay particular attention to this detail. The form further goes on to note that by signing clients are agreeing to additional testing and procedures in an amount not exceeding [blank space] prior to taxation. This is also highlighted in yellow. The client filled out $250 in the blank space. Please see the consent, signed by the client that was attached in my previous response. If there is any difficulty in opening the document please advise me and I will resend it. 

  3. While we were only able to provide curbside service, and clients were not allowed to enter the building, a small station was set up in our foyer where the clients’ forms are set on a small table and clients are provided with pens and a quiet area sheltered from the elements in which to read and sign any needed forms. 

  4. When the client called to ask about her cat’s trouble with urination we advised the client that this should be addressed fairly quickly, ideally on the same day, since male cats are at a high risk of developing a urethral blockage. The client was informed that we were fully booked but offered an outpatient admission (Day Admission) in order to accommodate a pressing medical condition. If the client thought that this may result in reduced level of care for their pet they had every right to decline, call a different clinic or take their pet to one of the two 24-hours emergency clinics in town. In this particular situation we deemed the added workload will be manageable, we also strive to provide care to our clients instead of sending them directly to the emergency clinics where wait hours can be very long and who are often so busy that they will send back pets who are not experiencing a life threatening condition. 

  5. An explanation of services was provided twice (see #1). The Reception role is administrative and payment collection only. When clients have further questions or concerns about the bill they will pass them back to the medical team to answer these questions. At this point the client received a 3rd explanation of the tests and charges. The urinalysis was not a charge beyond what the client agreed to since she agreed to the urinalysis during the first phone call and it was well within the amount the client specified she was comfortable with on the consent form. The tests was further discussed with the client at the time of relaying the results. We have no way of knowing what a person understands when reading a consent form unless they express a concern or ask a question at which time we are happy to explain. Since the client never asked or expressed any concerns about bringing her pet in, being rushed or not understanding the form, there is no conceivable way we would be able to know there is a problem for this particular person when we have had no issues to date with any other clients signing the consent.

  6. This is certainly an emotionally difficult time. However, obtaining consent is a requirement prior to services being performed. At no time is the client forced to sign the form or prevented from taking their pet and seek care elsewhere. We are also happy to provide clients with whatever copies of their records they wish. Medical records of pets are the property of the owner and will be handed to them at any time they wish. 
  

  7. Clients are able to pay by cash, eTransfer or credit card. Clients are not able to pay by debit when they are not allowed into the building. This was mentioned to the client when she was advised that we only offer curbside service. 
  

  8. Jupiter received 7 tablets of Onsior and only 10 tablets of gabapentin at his last visit in June. He received 6 tablets of Onsior and 30 (!) tablets of gabapentin at this visit. 

  9. Clients are well within their rights to request a written prescription. An equivalent to Onsior in human medicine is Meloxicam which is sold in 7.5 mg tablets. Jupiter needs 0.5 mg. Gabapentin is also a human medication. Jupiter needs 50 mg, human pharmacies carry only 100 mg capsules. 

  10. NS government considered Veterinary clinics as essential service only for the purpose of allowing them to stay open during the lockdowns to prevent undue suffering to animals. Veterinary clinics do not provide any human medical services and have the same rights and obligations as any private small business in NS. 

  11. The NSVMA is the regulatory body for all veterinary services in NS. 
  Please see NSVMA Code of Ethics posted on the NSVMA website under 
  Section 37. (a): "No member shall advertise to the general public a fee for a veterinary service". 

  12. The CVMA (Canadian Veterinary Medical Association- the governing body for all veterinarians in Canada) publishes a fee guide for each province on a yearly basis. This provides clinic owners with a framework with which to decide how to price their services. The fee guide for 2022 suggests a fee increase of at least 10% due to the steep increase in operating costs in the past year and projected for the coming year. According to the fee guide the cost of initial examination should be $109.00+tax. We only charge $98.09+ tax. The fee for urinalysis including collection is $127+tax . We only charge $104+ tax. These prices are well below what the Canadian and provincial governing bodies deem appropriate charges for these services in NS.

  13. While we understand the special attachment that people have for their pets, clients need to remember that having a pet is a luxury and not a right. Veterinary hospitals are a business like any other and are not obligated in any way to provide them with service, affordable or otherwise. However, the Canadian and provincial governments, recognizing the importance of pets' health, are providing subsidized veterinary care via grants given to the SPCA which then offers care to people below a certain level of income. These grants are made using taxpayers money so all Nova Scotians including veterinarians contribute to these services.

  Finally, I would like to point out that the client’s original complaint was a perceived over-charge. In this response to my explanation the client went on to make allegations of medical negligence, unfair, illegal or unlawful business practices, discrimination, price gouging, withholding information, gaslighting, manipulation and verbal abuse. I am confused as to why the client only brought these very serious allegations on her second response instead of mentioning them in her initial complaint. 

   

  Best regards 

  **** *****i DVM MSc

  
  

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