The Venom In The Terminology

A message came to me from a colleague about a post on LinkedIn drawing some attention. 

The post centered around what we (the veterinary profession) calls "futility of care." 

It was hard for me to read. Hard for me to internalize. Hard for the words to carry so much gravity and deliver so little of what our clients need from us. 

I don't know when it exactly happened. When that pivot point was. But somewhere along the way our message about treating out veterinary patients like family became treating them in the way we allowed.

I want the profession to start to pay attention to their words. I plea for the profession to also pay attention to their intentions. The gravity of the judgement within them;

Here are some of the most offensive;

"Pets are a privilege, not a right." Why would poor people deserve something to adore them? Someone to make you feel loved back.

"Futility of care." We decide when you stop caring, and, therefore,, stop looking for hope. Some pet parents struggle with grief and loss on a level veterinarians have refused to comprehend. People should be allowed to feel as they feel. Our job, well, that is to provide them the tools to do so. Hope is as integral in medicine as vaccines. Hospice is absolutely an acceptable avenue in medicine. Every kind of medicine. We, the veterinary profession, want to follow in the footsteps of our human counterparts and offer every billable option to our patients, so, why is it then that we also won’t offer hospice? Why are we so intent on being morally superior and yet still not empathetic to those we are here to serve? 

PS futility care is most often seen as cold and uncompassionate. Why would we ever use that term? Small animal medicine is about taking care of family members. Nothing is futile here right?

"Economic euthanasia" The fact that the profession has increased the cost of care so staggeringly fast that this is the last vestige of care we will permit, affordably. You cannot advocate for your patients to be treated like family and then decide they aren't worth options that work for the rest of the family. In 20 years of practicing medicine I have (hopefully) never denied care because it didn't work for me. It has taken me time to understand how different we all are. There have been clients who don't value their pets in a way congruent with care. 

"Replacement value" There are people who see pets much like food animals. They have a value that is defined by "replacement value." That dollar figure where it is cheaper to replace them than to fix them. Ask me to expose my soft vulnerable underbelly and help your pet out of a difficult situation and I will jump in. There isn't one person at the vet hospital who wouldn't jump in with me. But, don't ask me to look into that disposable pet and see them as replaceable. 

Elsa.. recently rescued and adopted

This blog comes from a post from a fellow veterinarian who started the post with;

"Today I had a client for which I refused treatment." The veterinarian went on to describe an elderly patient at the end of their disease. The pet parent bringing that pet is was back at their vet hospital, again, seeking help. The parent did not see the pet in the same light, the same degree of dying, that the veterinarian did. The pet parent wanted help. With that plea for help, with nothing more to offer that was feasible in helping the pet get better, with only euthanasia left, the vet posted that they were refusing treatment because watching this pet show up at the clinic was stressful for the staff. Like so many other instances this is a veterinarian who refuses to see the pet in the light we make such financial gains from and meet them where they need us to be. The parent wants to feel hope. They are aren't ready for the passing of their family member. Futility or not, there is absent compassion here for what the pet parent needs. We are turning our back on them when they need us most. Why can't anyone say, "what can I do to help?" When is declining a hand of empathy abandoning our responsibility?

I replied; "Today you decided to stop being a doctor."

For more on my veterinary hospital please follow us on our Facebook page; Jarrettsville Veterinary Center.

YouTube channel here.

For more information on the non-profit work we are doing to help save pets from economic euthanasia please follow us on the Pet Good Samaritan Fund page.

Pawbly.com for pet questions and pet care cases with cost of care included.

When The Veterinarian Decides Who Is Worth Care

"I need to talk to you privately."

It is the beginning of another chaotically busy day and this is my least favorite preamble to start it off with. I tell myself to stop what I am doing and just go face the discussion head on. Rip that band-aid off and then return to GO. It is the only way I will get to the end of the day intact.

Magpie

She is the vet hospital floor manager. She has been here for about 9 months. (New to us by the law of averages that the rest of the staff holds. Most have been here for over 5 years). She is the Sergeant who keeps the cadence. Monitors the staff and doctors to stay on time. Ensures the blood tubes are labeled and the diagnostic table stays organized and orderly. She fills in to hold a patient, address a problem with a client to keep the vets on schedule. Picks up the phone to answer the random, often completely inane question. (Like yesterday's; "my dog ate a treat toy. What do I do?" No idea of size of dog, size of treat toy, what said treat toy was made of, or how well their dog chews before swallowing). She is on her feet, in everyone's business, and still keeps a smile on her face and an optimistic cheer in her stride. She used to manage race horses. She is ideally qualified for this crew of, (authors note; I wanted to use the analogy about 'busy as a beavers' but it just might be construed aberrantly.. ;-) ),, let's say ants... yes, or bees, or thoroughbreds, they all substitute to make my point. 

Storm, morning naptime

The conversation centered around one of our oldest clients. Old in both age and years with our practice, (must be about 70, as he is about 85). His family has farmed the lands in this county for over a hundred years. He is known by every person who has lived here for more than a few months. He is an indelible character. Always a farmers baseball cap atop his head, (which I have never seen naked). Always a pair of pants missing fabric in key places. And, always a long tale about some physical ailment of his unrelated to the cat he has brought. And, yes, always a cat. He used to have dogs, farm dogs, (of course), but cats, he has  decided are far easier to care for, and he far prefers their company. He lives in an equally old, equally worn out, farm house. Every room of his home has been converted into a cat dormitory. Every room is sectioned by feline family. All of his cats, 40-something in total, are related. He is as old school rural farmer as they come. He absolutely, unequivocally loves his cats. They are his family. 

"I don't understand why you didn't tell him that he had to put the cat down?" She is referring to his cat that we saw late yesterday. His cat was pitiful. Dying, and in horrific shape. He was matted, foul-smelling from feces that had caked on his back end, and emaciated. He was also sweet, gentle, purred the whole time, and knew only love from a human. His cat needed help, he knew it, and he was here looking to us to provide it. We are, after all, doctors. This is, afterall, a hospital.

Her question is so heavy you can reduce to a few minutes and a clock that ticks impatiently. 

I know that I have to try to answer this for her. Find some analytical reasoning in her black and white perception. I also know that her question comes from a place of respect that she trusts me, and concern that she is a part of a patients suffering she doesn't feel right about. 

The answer to this question is seated in the ethos of who you are. It comes down to this; who are you here? Specifically, who are you in veterinary medicine. 

The successful small animal veterinarian is able to keep their business open because they understand every pet parent sees parenting differently. Veterinary medicine exists in a place of whim and will. Every pet in every home is there as a guest in the eyes of the law. While they may have some basic rights in a few states they are still considered property. Pets are the reason veterinarians worked so hard to attain a degree. They are our purpose. They influence us. When you are so deeply invested in something it becomes painfully purposeful. It becomes ingrained in who you are. This is a curse as much as a blessing. Understanding the emotional seat of pets is imperative. 

Frippie. Also morning naptime

If my purpose is to help pets I have to provide it within the confines of what works for their family and caregivers. Veterinary medicine is forgetting this. We are getting judgemental and restrictive as we become more profitable. We have influence tied to our preferences and our gate-keeping for their health. It leaves people like this farmer in a place where he now will not go to the ER, and he will not go to other veterinarians. They have judged him, lectured him, reported him, and he will not share his life and the dearest individuals he adores. His cats are his family. He will protect them as such. 

A practitioner who wants to stay in the community they live, work, and practice in, needs to meet our clients where they are, not where we want them to be. This is the key difference that specialty medicine is lacking. You cannot be a part of someone's story without being embedded within it.

His cats are crowded. He has too many. He knows this. He spends all day everyday cleaning for them. Feeding them. He treats them the way the rest of the world treats the animals they eat. Crowded and housed like they cannot have freedom to pursue free-will. Why do cats and dogs deserve different standards of care? Different living standards? Why if you think they are more deserving of minimum standards of care and yet not deserving of end of life care like humans are? Every hoarded started with love and good intentions. Every pet under their care still deserves care.

This is what she didn't recognize yet.

The view from my kitchen window

For every client that I see who doesn't want to euthanize their pet because they do not feel it is their place, their right, their duty, their decision to make, the profession has to be respectful of this. Hospice is their right as much as it any other aspect of dying is. This farmer has never put a cat down in my clinic. Whether or not I can do the same with my beloved pets is not relevant to his decision. He loves them. He cares for them. He dedicates his life to them. Do his cats love him back? Yes? Is he wealthy, influential, hold some power over others that can afford him a different set of rules or standards? Is this the country we live in now?  Is this yet another instance of inequity deciding who is or isn't worth empathy? How many cats are looking for homes in my county? (Hundreds). Do these facts influence our compassion?

A decade ago we had a long, hard conversation about his colony. It took me years to convince him to spay and neuter. It has been a decade of no kittens, which was very difficult for him to give up. It was what his cats needed. It took him a while to see their world from this perspective. There has been a huge decline in respiratory infection, illness, and death outside of old age from this. He needed to see the colony from this vantage point before he could give up the joy of having kittens. This is medicine. This is the emotional glue trap that having pets causes. This is the life every veterinarian chose even if we couldn't see, or comprehend it during the early years or vet school.

For more on veterinary care, my diary entries, and the current state of vetmed please follow this blog, see me on YouTube, Instagram, BlueSky, and our Jarrettsville Veterinary Facebook page. 

Pawbly.com for pet care questions and cost of care cases.

We also just started our non-profit Pet Good Samaritan Fund. See our stories of helping pets in critical need there.

Waggle Partnership Letter

 Hello,

I am a practice owner who is a veterinarian with a big heart first, and a superhero ethos to save pets lives second. From this perspective, (and the current ethos of corporate take-overs in the vet sector), the burden of helping more in dire need by offering affordable care has become overwhelming. It was with all of this at our doorstep that we created our own 501c3 about a year ago. The Pet Good Samaritan Fund purpose is to encourage other vet clinics to offer more affordable treatment options to pets in dire need of interventional care. We did this because we know pet parents need help, and we also know pet providers need a safety net to reduce financial loss and risk.  

Sephora

My veterinary clinic, Jarrettsville Veterinary Center, is a small animal private practice that has always been committed to helping the pets in our community. We never deny care and we move mountains to make miracles happen. This is a daily endeavor at JVC. Yesterday was our first case that we utilized your platform through. In the past we have done all of our fundraising through our own social media outlets. While I cannot always defeat disease, fate, and the inevitability of death, we have never lost a case from having to resort to economic euthanasia. My whole existence as a human and veterinarian is committed to ending this widely accepted, (and almost unanimously approved vet med community), option. The thought that a deceased disease afflicted/beloved family member is better off dead than taking a financial risk/offer to be compassionate and fulfill our veterinary oath by actually treating the patient, is archaic, cruel, and unjust. I am as vocal about this personally as I am publicly. This profession has strayed from who we wanted to be, and why we are here, and the pet parenting public knows it. Our veterinary suicide rate, the massive buying of hospitals for coroporate profits, and the skyrocketing cost of care prove this. I believe that with key partnerships we can help pets, their families, and veterinary care providers. We can minimize financial risk to providers, and we can all feel good about caring, (and actually practicing medicine), again. It is merely a challenge to think outside of the capitalistic goals shareholders place and start offering palatable, beneficial, meaningful care that everyone can feel good about. I also know that the rest of the veterinary decision making practices need a template and examples of how it can work. Our non-profit and for profit vet hospital have made countless examples of how we can be both doing good and doing well.

Yesterday we saved Sephoras life because of two things; first, her family advocated for her, second we have the ability to do so. The rest of the happy ending outcome was a little bit of trying, asking, finding you, and having the other key factors in place. We have been here before. I am not afraid to try, and I am determined to leave vet med better than I came into it.

Surgery prep

I am hoping to connect with you and make more miracles happen by extending the ask to not just the public at large, but to the gatekeepers; the veterinarians who don't know what tools to access to be a part of a worldwide movement back to compassionate care that really saves lives. The lives of all of us who need our pets as the vital part of our wellbeing and the pets themselves. I truly believe that a big part of the answer to all of the unrest, unhappiness and fear in the world can be solved by protecting the place pets have in our lives.

Thank you for your time and your platform,

Sincerely,

Krista Magnifico, DVM

owner Jarrettsville Veterinary Center

Founder Pawbly.com

Founder Pet Good Samaritan Fund

pet parent, exhausted practice owner, and total-bad-ass pet savior in residence..

PS Sephora's pyometra surgery took me 30 minutes to do. It was the most rewarding, (easiest) surgery of  my day. Her moms gratitude was inspiring. This life I live (while exhausting) is so rewarding I wouldn't exchange it for anything. Not a yacht, or a villa, or a tiara. Who else gets to feel this good about 30 minutes of their day? The more you give the more you get back. 

We did not do any diagnostics outside of a 1 view lateral xray. We declined everything to put all of our efforts, and resources to her treatment plan. We take risks, there is great reward, and all of us feel good about trying. This is life. You jump in. You give yourself to others. That is medicine at its most powerful.

Corporate Acquisition Inquiry

I get these phone calls and emails daily. It seems that as the available pool of private practices gets smaller the tactics and tactful phishing gets more invasive and obnoxious.

Here is todays example. I have half a mind to add the phone number. The volley serve to texting me at 5 pm on a Friday.

Hi Dr. Magnifico, this is XXXX from VetEvolve. I hope it's okay reaching out by text. I am very interested in learning a bit about Jarrettsville and your plans for the future of the practice. Are you available for a quick call next week to introduce ourselves? 

Looking forward to hearing back.

XXXX

Practice Partnership Specialist 

xxx

George.
Multiple unblockings (UO) and a PU surgery

Myreply;

If you are reaching out bc you work for a corporate entity seeking ownership than no. It is not ok. It is predatory, rude, disrespectful and unprofessional. You are also working for people who intentionally and purposely make pet care so expensive it costs pets their lives. It also costs pet parents their ability to trust other veterinarians. Think about what your paycheck costs pets. 

Doc, linear foreign body surgery.

Thank you for sharing your perspective. I do appreciate your passion and commitment to the veterinary profession..and also the well-being of pets and clients alike.  

At Vetevolve, we are not about being predatory or undermining the trust between veterinarians and pet parents. Our focus is to support practices, maintain each unique culture, and provide resources to help teams thrive and better serve clients and patients. Affordability and access to care are priorities for us and we are striving to make a positive impact.

I understand completely if you aren't interested in further discussion, but I want to assure you that our intentions are grounded in supporting and preserving the veterinary community, not taking advantage of it. 

If you would ever like to share more about your concerns or ideas for improving the industry, I'd genuinely value the opportunity to listen. 

Warmest Regards,

XXXX 

Lola, pyometra surgery

I would be shocked if all of that pitching garbage had any teeth. Let me know which patients of the other corp owned practices who are turned away due to financial restraints that I can send your way for affordable care   I'll give them your name. 

Send me one case that you made affordable. 

You are drinking the kool aid. 

I just visited your website.  There isn't one word about patients. Every single page and line item is about people. So if your website is any indication of how much you care about your patients it's zero 

And for the record my husband and I have 40 years of combined service Bn the navy and coast guard. 

Don't say I didn't warn you. Eventually some bigger fish will send you packing. They treat their people as bad as their patients. 

Dixie, Pyometra surgery

I assure you,  my heartfelt thoughts are based on what I witness.  I don't have cases on hand from the hospital level...but our integrations and operations teams would be sure to provide  for any owners who are moving forward with discussions.

In reference to our website, I can direct you to the resources tab where there are videos and posts... where the veterinarians speak about community and their clients. By implication clients are happy because their pets are taken care of ...but you raise a great point ..a heightened awareness of protecting and caring for the animals could be more prevalent instead of mostly mentioning vets and their teams.

As for your combined service, I appreciate what you have done for our country... I admire all branches of our military. 

Lastly, I have my eyes wide open here....and it's not my first rodeo in M&A.  You have a valid point that companies merge or close without warning.,.being tied to PE does come with occasional risk...but if I can add on to the culture from what I have learned in the past few decades in the space, I will. So many of us here have come from other places and want to right some of the wrongs we have seen in the past.  I don't view that as having Rose-colored glasses ..its just because someone has to take the first steps to do it right.  

Thanks again for your thoughts..I do value your opinion...

Have a great weekend and much continued success this year. 

Garfield, trauma, fractured jaw

There is not one single thing that is in place in your organization that puts pets first. The whole concept of the corp ethos is about profits over individuals. As a civil servant it is unethical and deceitful to even try to portray otherwise. 

At some point you will ask yourself what your efforts contribute to our society. What legacy you are building. Who you are, who you represent are the antithesis of what the pets who we consider family need. They need love, compassion and kindness. Medicine should embody this in every molecule of our being. Every action, word and decision that we make. 

It is the dawn of shooting CEOs in the back and the public cheering them on for it. This is the world you built. These are the consequences of greed, wealth and your idea of power. 

It's shameful. I'm not afraid to tell you that. We, as the spokesperson to our companies, have nothing to say to each other. 

As the individual You just aren't looking deep enough into your own mirror. 

Seraphina and Dr Ahrens

...and PS XXX, my success is infinitely easier to achieve because of two factors; 

1. Your business model makes my new client patient appointments robust. Your "one and done" visit ratio is much higher than mine. You will price them out of care once and they will never come back. That's the price of playing with the lives of our family.

2. I possess qualities you will never have; genuine compassion and utter determination to save lives.

If you aren't saving the souls you came here to serve you are selling yours short. It is not about the "if they can pay we can help" it is about altruism and your own humanity.

"If you feel pain, you are alive. If you feel other people's pain, you are a human being." Leo Tolstoy.

If you are a veterinary professional looking to save the lives you came here to be the kind hand of healing for then please reach out. Medicine was never intended to be driven by profits alone.

For more on the cases above see the other blogs, my YouTube channel, Jarrettsville Vet Facebook page, and Instagram.

Leave No Patient Behind

George is a 9 year old indoor domestic short haired cat who visited us about a month ago for straining to urinate in the litter box, and producing only small amounts of urine. 

He presented again to us yesterday; unable to urinate. George is now a "blocked cat" or, UO cat (for urinary obstructed) cat. 

He found us, like they all do, with a little bit of luck, and a parent with limited resources. 

When he arrived on Saturday morning at the vet clinic we suspected that he was blocked. We also hoped that his parents had a rainy day account of immediately accessible funds so we could send him where he needed to be; the ER. The ER these days require a $4,000 deposit for this. It is beyond my comprehension what they do with that $4k, but it seems ubiquitous enough amongst the lot of them so it must be accountable in some list of line items. 

Within 20 minutes of Georges arrival at my clinic my phone rang.

"Sorry to bother you, (I was away for the Thanksgiving holiday), but, we have a blocked cat here." 

"Is anyone there willing to unblock him?" I asked.

"Yes."

"Ok, then we will figure out how to pay for it later. Have the owner go through our emergency sheet. Have someone else in the room with them to serve as a witness. And, make sure she is ok with us sharing the story and photos. Call me if you need anything."

"Ok. What would happen if we didn't help these cats?"

"They would die at home a miserable death, or be euthanized. Just like all of the rest of the cats. You know that." I replied.

My office manager agreed to go over everything with George's mom. She was working from home, on her day off because that's what George needed from us. George is a perfect example of who we are. He is deserves to be cared for. He is why I went into veterinary school. He is my WHY as much as any of the regularly paying customers are. Maybe more so.

George, the morning he arrived at JVC.

Here is the Facebook post we put up that morning; Georges first FB post here

"This is George.  He has found himself in a hopeless situation today.  He is blocked, and his mom only has $400 available to help him.  At our practice unblocking runs $800 - $1,000.  Despite the lack of funds we’ve agreed to help him, because we know without help George will die.  George and his mom could use some help financially with the cost of his care and treatment over the next couple of days.  Donations can be called in or made in person directly to George’s account.   Donations can also be sent via PayPal to jarrettsvillevet@gmail.com, please note that your donation is for George.

A big thank you to our kind hearted Dr. Ahrens who agreed to stay late to help George today.  ❤️"

A few hours later we posted an update;

Waking up from surgery.

"George is out of surgery and resting!  Thank you to all who have donated.  Please know any funds raised in excess of what is needed for George will be used to help another pet in a predicament like George. 

We truly couldn’t do this without the kindness and generosity of those who support us in our mission to help pets like George."

Two hours after the first post was put up we had raised $1900 for George. 

I posted a video on his story. Find it here; Inspire an army to save lives video here.

George update

One day post op. Looking good George

He is feeling SO much better with the help of our rockstar Saturday staff. He is getting his sq fluids currently (he is awesome at it) & taking his meds like a good boy.

So, George is a miracle, right? I mean its an incredible thing to be able to be given the treatment you need at a price your client can afford? Why doesn't every veterinarian do what we do? 

Well, because they think they can't. I hope to set an example of how this can be done. And remind everyone how good it feels to help save these lives.

We take a can-do approach to these cases. We take a leap of faith that we can save these pets first of all. We only offer payment plans, pro bono, take a risk on non-payment for cases that we think will survive and have a good return to a quality of life. We do not offer this to patients used for breeding purposes, people who are abusive, unkind to the staff, and who we do not believe will continue to provide routine preventative future care. For all of the cases we do not offer pro bono, or potentially not pay us back, we do offer to have the pet parents the option of signing over their pets to us. We will find a home for them, or keep them as our own for the rest of their lives. While this might sound cruel or unkind there are situations where pet parents realize they cannot provide the care their pets need, and they put this above all else. These are the people we want to over extend ourselves for. Sadly, almost everyone would rather their pet suffer, remain without treatment, and ultimately die than give them up. There was a case of a 4 year old dog who swallowed a corn cob who died recently after the owners declined the offer to give lifesaving surgical intervention. They watched her die over 4 days while they tried to raise the $3500 the ER required as a deposit versus signing her over to the rescue who offered to take her and get her the surgery she needed. 

Here is the document we use for these cases. We ask the pet parent to initial each line and then give them a copy for their records. If people would come to me and say "I love my pet so much that I would rather have her treated and alive with someone else than dead with me." I would do everything to save them. I don't think I am alone with this. 

For more information on this please see our website; Jarrettsvillevet.com see the tabs for Financial Assistance and Immediate Help.

All clients who cannot afford the estimate for needed care at Jarrettsville Vet must agree to and sign the following;

___ I understand this is an emergency.

___ I understand my pet would be best served at an ER, ICU, referral center.

___ The only reason that I am NOT at the ER/referral center/ICU is that I cannot afford it.

____ I understand that my pets current condition is (we fill in our differential diagnosis here).

____ I understand that I may not fully understand the extent and severity of this condition without a referral or additional financial resources

____ I have been given an estimate for care;

I can   ______        or    _____       cannot afford this estimate.

____ I understand that the estimate may change as my pets status changes. We will offer a payment plan if we go over your estimate.

If I cannot pay the estimated deposit for care I will;

1.       Sign a letter of collateral. If the invoice is not paid in 90 days the collateral will be transferred to JVC at my cost and the item will be sold for payment. Collateral item is; ______________

2.       Allow my case to be shared on any social media platform of JVC’s choosing to try to raise funds for my pet and awareness for their condition. This will help pay knowledge forward and maybe spare another pet from this condition.

3.       Follow all suggestions to include full story write up, starting a Go-Fund Me, sharing the fundraising efforts of JVC, and assisting with future fund raising projects at JVC

4.       Volunteer at other non-profits to pay it forward.

____ I allow JVC to share photos, videos and pertinent patient info for an indefinite period of time at their choosing.

____ I allow JVC, Dr Magnifico have full access and rights to my pets story. Past, present, future,

___ I will provide updates as asked and allow JVC, Dr Magnifico, the GSF, TPGSF, to share my pets story.

___ I understand that JVC has offered to help me care for my pet as an extension of compassion, kindness and shared goals to help end suffering and provide care regardless of financial constraints. It is with this in mind that I will be kind, compassionate, and generous with the actions and comments about my pets care.

___ We reserve the right to refer care back to an ER/ICU/specialist at any time.

 

Our Immediate Need Policy and Expectations for Non Clients are as follows: 

· We strive to offer affordable options for pet owners.

We usually require a full deposit at the time of intake for any emergency services. Our team will go over an estimate for your pet’s care once your pet is assessed. 

Please visit our website for additional resources to help with paying the balance. 

CareCredit may be utilized. You can apply for CareCredit via their website - https://www.carecredit.com/applyo Payment plans will be offered only to existing clients who have applied for or exhausted CareCredit. Payment plans are provided via Vet Billing

· Any financial concerns must be discussed at the time of receiving an estimate. 

· If you cannot afford the exam fee, the estimate for diagnostics and the treatment plan we will ask what is feasible for you financially, emotionally and physically to care for your pet long term. You are asking us to put your pet above the cost of running a veterinary facility, paying our staff and the emotional burden we take on with these cases.  

You will receive a copy of our Client Rights and Responsibilities and be expected to abide by it. We will not tolerate abrasive behavior directed to our staff. We are here to help you and your pet and expect to be treated with kindness. 

We will work together as part of a team for what is in the best interest of your pet. 

In working within the confines of financial concerns we may discuss with you waiving some diagnostics to keep the estimate within your budget. 

If it is determined that it not feasible for you to care for your pet long term, or if you pet is in need of immediate emergency care and we can not come up with a reasonable financial plan we may discuss surrendering your pet to one of the rescues we work with so that may receive the lifesaving care they need. 

· Jarrettsville Vet is a small animal general practice, we do not have staff in the building overnight. In most cases you will be expected to pick your pet up before we close. 

· We are working your pet in as an emergency. This means that the veterinarian may defer update calls to the support staff. Please rest assured that if your pet’s condition worsens you will receive a call. 

· It is our policy that if your pet is in need of emergency surgery and is intact, they will be spayed or neutered at the time of surgery. This is non-negotiable, if you are not agreeable to this clause please seek services elsewhere. All patients will also be vaccinated for rabies and given a microchip with Jarrettsville Vet listed as the contact for the life of this pet.

· You will allow us to share your pet’s story on Pawbly.com and social media at the discretion of the veterinarian. 

· If you receive funds from our Good Samaritan Fund you will participate in JVC or Good Samaritan Fund fundraising or volunteering and agree to the terms and conditions of our Good Samaritan Fund Recipient Policy. By signing below, you are indicating that you have read and understand our Emergency Services Policy.

Letter To UPenn Veterinary Teaching Hospital Seeking Access To Care

 Access to Care

There are those of us who live our lives with the hope that our pets will find us worthy. We spend the majority of our time giving gestures of thanks for all that they give us. We feel humbled by how little their loyalty costs, and yet we still want to offer them more knowing it will never repay all that they give us. The relationship between ourselves and our pets, with whom we share the most painful, joyous and raucous moments of our lives, is unsurpassed. Our pets are our truest, most trusted, most faithful companions. They give us so much without asking or expecting anything in return. Most of us would chose them over any other person, even those we call a relative. This, this single sentiment, has forged many a veterinarian to face arduous years of disciplined study and turmoil. Those quiet, unseen moments with them for that one soft purr, a gentle wag, a velvet ear and wet nose, for these we would, and do, give everything. 

Jenn and Johnny Cash

Johnny Cash was the beloved dog of our hospital manager Jenn. He was growing older and like most large shepherds, was struggling with issues associated with his breed and age. He needed help getting up, staying up, and his self- assigned guard duties pressure suffered as these progressed. Jenn was determined to do everything for him. During the course of almost a week he went from not feeling well to unable to stand, eat or interact. Over that time he was given an immense amount care from the staff of our clinic. When one of our own is not doing well the hive swarms around them to lend a hand.

This is a story of love and the dedication/devotion that all pet parents feel when their pets life is tenuously suspended on the precipice of life meeting end of life. Veterinarians, those of us in the sweaty, grueling, chaotic trenches of day-to-day medicine life forget this. We lose sight how much we are needed. How much power we yield, and how devastating the loss of our companions can be when we fail to live and deliver the purpose our knowledge and skills provide. There is the potential loss of a life with every patient we see. We veterinarians know that. We are so used to it that for some it is an acceptable, albeit an inevitable sequela that it permits a degree of indifference some call a "healthy boundary." It allows us to practice without prejudice and without emptying our own internal well so thoroughly that we can go on to help others. What we forget is what the loss of these patients does to their family. The void of losing their unsurpassed love, and the living through the phases of grief that loss requires. But, the real pain of too many of these situations is the cold, indifferent manner that we treat those coming to us for help. This is the place that vetmed has gotten itself to. We did not come here to be this. We must never forget why we are here, and what kind of legacy we are building as we walk each footstep of our professional life.

Within the week Johnny Cash's decline he was given 5 examinations, 2 ultrasounds, 4 full lab works, 2 internal medicine teleconferences, 3 x-rays, and two radiology reviews. Every person at our very busy practice was working to help him. 

When his disease eluded us, and he continued to slip away, we knew we needed more help. We did for him what we would do for every case we cannot figure out fully, we referred him to those who could. In our part of the country the most competent place we can send a patient is the University of Pennsylvania Veterinary Teaching Hospital. 

The veterinary teaching hospital is the foundation of all that a veterinarian holds as the building blocks of who we are and all that we hope to be. There is no other place that holds greater power nor greater minds. These institutions employ the most notable, credible and wizard-like masters. For the greatest medical minds of our world, these 30-odd colleges represent the best of our abilities and the fringes of our most modern advancements. They built us, each one of us, and for that we are forever indebted. They also hold unparalleled optimism for the cases we cannot heal. With great power comes great responsibility. This is where we sent Johnny Cash as our last hope to help him, and Jenn. 

This is the communication sent back and forth over Johnny Cash's care. The first is Jenn's letter about her concerns and experience when she brought her very sick, very fragile, very much loved Johnny Cash to UPenn. What concerned her the most, as we look back on this, was how hard she had to advocate for her dog. How hard she had to insist on being heard, and how, if she hadn't been an "insider" and hadn't had me on the phone, 3 times during her stay at the hospital, she would have paid $6,000 to $12,000 to be given his diagnosis. Within the course of 4 phone calls (1 to transfer him in, and 3 while she was there) I, me the referring vet, had to repeatedly remind them to use the skills we were all taught. Listen to the history, listen to what the patient tells you during the exam and start with a presumptive diagnosis and a minimum database for that presumptive diagnosis. JC needed 1 abdominocentesis after an ultrasound and we had our answer. He came back to his vet and we helped him from there. All of this could have, should have, been done within a short time. We were very clear on our needs, hopes, and expectations. We just weren't heard.

What strikes me as the most unacceptable part of her experience is that she wasn't treated as the instrumental part of the patient care experience she should have been. This is a teaching hospital. The safest place for anyone to be. The place where mistakes are used as the crucial crucible of molding future veterinarians. It is the place where asking  questions, challenging all aspects of medicine, and putting the patient above all else should happen. It should be encouraged. Nothing is more important than preserving the bond between a pet and their family. Nothing is above being kind when faced between choosing being right over being compassionate. This is another crucible of a veterinary teaching hospital.

Jenn's letter to UPenn after her visit;

Good Morning,

I am sorry for the delay, as its been only a week since I lost my beloved dog and articulating our experience in a coherent manner does not come easy.  

I do want to preface this email by saying that I have utilized both Ryan Hospital (2019) and New Bolton (2021) in the past and was incredibly pleased with my experience and the care that my animals received. We were treated with respect and compassion. This experience was so outside of the norm I know from Penn.  As stated in Dr Magnifico's email, she had called ahead as the referring veterinarian to the Emergency Department hoping for a second set of eyes on the case. We were asked how far away we were to which we stated about 2 hours. Records were forwarded outlining all we had done in our clinic and Johnny Cash was loaded into my car on a stretcher. I kissed his head and promised that we were trying to help him. 

I arrived at UPenn on 1/23/2024 around 3: 15 pm. The stretcher was loaded onto a gurney to take him back. I gave my information at the desk and signed all consents. Our stretcher was brought out along with the blankets that he had soiled. 

Around 4:20ish I met with a 4th year student to give Johnny Cash's history. 

Around 6:30ish I finally met with the attending to go over her assessment, more than 3 hours after we arrived. I was told that we needed to start "at square one" with diagnostics. It was recommended that fluid be pulled off his abdomen for assessment. I was told his pulses were low. There was concern for cancer and that he would need to go to the ICU. I was told a urinary catheter would be placed. I questioned this as he was not outputting urine despite being on fluids and was told this was to keep him clean. My estimate to start was $4,000 - $6,000. I was a bit in shock as we had called ahead to see if we could send him for a second set of eyes, along with record of everything we had done in our clinic over the prior four days. I wasn't sure why we would need to start at square one. When I questioned this I was told nothing was open at this time to do any diagnostics, ultrasound, etc.

I questioned why we were told to come up, two hours away, if there was no ability to provide the services that were requested. The attending told me that she would look through the referral log to see if there was anything recorded there, which she stated there was not. I was given the option to return in the morning when we could have the necessary testing which would eliminate the cost for overnight care and likely be around$2,000 but result in a total of 8 hours of driving with a dog who was in critical condition. After a lot of back and forth we agreed to at least pull off the abdominal fluid before we left. Some time around 7:30 pm his abdomen was tapped. Around 7:43 pm we were given the news that the fluid was septic. My estimate changed from $8,000 to $10,000 to start as he would need an emergency ultrasound and surgery. I made the decision to take him home to euthanize at our clinic in the morning.

As a pet owner, and someone in the veterinary industry, I have several concerns;

• I watched as less critical pets had histories taken quickly. They quickly met with an attending and  were even discharged before I had even met with the attending. If my pet were so critical an ICU was recommended shouldn't he have been assessed before the easy "in and out" cases? (Specifically a Golden Retriever with an eye injury stuck out in my mind, (although there were others). Are cases not assessed for urgency? (Maybe if mine had he would have gotten the services he needed before clinicians left for the day?). Your own website states "Patients are seen on a medical priority basis. Waiting times for clients can vary depending on the caseload at the time of presentation. All patients in life-threatening situations are immediately brought to the treatment area, where the emergency clinician performs a physical examination and provides emergency stabilization." Given our timeline this does not seem to be accurate.
• I was told that my pet could receive "better care" in the ICU than what he was receiving at home overnight. Yes, my dog was hospitalized at home overnight, under the care of someone who works in the veterinary industry and under the direct supervision of a veterinarian. These were the exact words used, and they stung.
• My dying dog was given no pain meds, even when we knew his abdomen was septic and I stated he would be euthanized in the morning at our clinic. A dying dog who was septic was discharged and given no pain meds.
• A week later Johnny Cash's records have yet to be sent to Jarrettsville Vet, I am glad no next steps were hinging on this.
• While I could have likely come up with $4,000 I was told that the $4-$6k estimate was "to start" I work in the veterinary industry because I love animals, unfortunately a love for money does not align with a life in our industry. I do not have unlimited resources. $8-10k to start was completely outside of reachable, and I fear this would be the case for many. I know most of our clients would not be able to manage this
• I have read over your Client Rights on your website, (see here), Johnny Cash and I were failed at every bullet point within those rights.

As humans we have evolved to love our pets as a part of our family. We love them in many cases more than we love many humans. We often grieve their loss more than that of a human as well. Somewhere along the way many in the veterinary industry seem to be capitalizing on this love and in turn emergency care is becoming out of reach for most. If this care is out of reach for someone in our industry I fear what that means for our clients.

I am grateful that I brought my dog back home. He was taken in for an emergency exploratory surgery at our clinic as a last effort to save him, and although that was not possible, I did get my answer (diagnosis) and with that came peace in letting my beloved companion slip away peacefully. I was only given this because I work at Jarrettsville Vet. My heart breaks for the average pet owner who would have had to make the decision to let their pet go amidst an impossible starting estimate, never knowing the diagnosis. 

While we worry about mental health in our industry the reality is there is a pet owner who is more often than not, loves their pet at the other end of the leash or the carrier who deserves to be treated with compassion as well. I hope relaying my experience somehow helps others; I have the unique perspective from both ends of the spectrum - someone in the veterinary industry and a pet owner.

Thank you for your time,

Jennifer

There were two phone conversations that occurred as a result of this letter. One with the UPenn social worker to better describe the care and client experience Jenn received. The second phone call was with the Emergency Hospital coordinator and an ER clinician. It was not helpful to Jenn, nor in any way reassuring to me that what happened to her and Johnny Cash, wouldn't happen again this evening. There was an apology for Jenn's loss, a defensive posture that he was well cared for at their facility, and a lot of excuses and firm language that they are compassionate, AND that they do offer a spectrum of care with affordable options being given when clients have financial constraints, and hurtful commentary from two veterinarians who want to stand by all of the reasons Jenn's concerns were wrong. It was a shocking phone call that further reinforces the state of veterinary medicine in this country.

After we got off the phone with UPenn and after we had put all of our thoughts, grief and taken the time to bring Johnny Cash's case into the learning and call for concern with the state of vetmed, we decided to write an open letter to all of the referral centers around us.

Jarrettsville Vet never puts a pets ability to have a chance at a treatable outcome, and a clients ability to have hope, behind anything other than our mission to Always Be Kind. This is where medicine starts. Where it lives and the only place it can succeed. There needs to be a better place for the conversations to start then the estimate. 

The letter reads;

Dear Referral Facilities,

    We hope that this letter finds you well. We are writing in regards to the patients and clients of Jarrettsville Veterinary Center. It's our hope and goal to honor our promise to stand by them in doing what is best for their beloved pets.

    We understand that emergency situations can arise unexpectedly and we want to ensure that the best care is provided to our clients/patients during these times. We also believe that every life is precious and deserves to be treated with compassion and respect. For this reason, and any other, should a decision ever need to be made to euthanize a mutual pet due to financial constraints please reach out to our facility.  We want to make it clear we do not condone this type of practice at our facility.

    We are dedicated to providing the best care possible regardless of financial constraints. We believe that every pet deserves a chance at a happy and healthy life. We will work with you and our client to find a solution that is in the best interest for all involved. Dr. Magnifico is happy to include her email and personal cell phone number to the DVM's and practice management staff to offer help when needed.

    Kindest Regards,

    Krista Magnifico, DVM

    Owner Jarrettsville Veterinary Center

This letter was sent to about a dozen referral and emergency practices within a 2 hour drive from our clinic. As of today we have received these affirmative acceptance replies; 

The UPenn Ryan Veterinary Hospital and Mason-Dixon ER in Shrewsbury, Pa. and the Animal Emergency Hospital in Bel Air Md

This week I tried, again, to refer a patient to UPenn. I was not able to provide the transfer without an authorization that the client would be able to afford the projected estimate even though, as in the case above, the diagnosis, diagnostics, and treatment plan were unknown. They, once again, and as they have previously, were more concerned about sending a client with financial security to allow for the full spectrum of possible care, then helping a patient/client in need find care that mattered to them. 

 

School of Veterinary Medicine

Department of Clinical Sciences & Advanced Medicine – Philadelphia

3900 Delancey Street

Philadelphia, PA 19104

 

 

July 11, 2024

 

Dear Dr. Magnifico,

 

Thank you for reaching out and for your thoughtful message. We appreciate Jarrettsville Veterinary Center's commitment to providing compassionate care to all pets, regardless of financial constraints.

 

At Penn Vet, we share your values and dedication to the well-being of our mutual patients. We understand the importance of ensuring that every pet receives the best possible care, especially during emergency situations. Your offer to collaborate and find solutions to avoid euthanasia due to financial difficulties is truly commendable.

We will certainly reach out to your facility if we encounter any situations where financial constraints might affect the decision-making process for a pet's care. We kindly ask that you discuss estimates with your clients and notify us of any financial concerns when referring a client to us. As we have many clinicians that rotate through our emergency service, this will be a critical step in communications to ensure that the emergency care team helping your clients understand the terms of your support and that nothing is lost in the transfer of information. Having your contact information will be incredibly helpful, and we appreciate your willingness to financially assist clients in such circumstances.

 

Thank you once again for your partnership and for your unwavering commitment to the health and happiness of the pets we collectively serve.

 

       Sincerely,

        PennVet -Ryan Hospital of the University of Pennsylvania

I will be reaching out once again to UPenn to discuss the practice of putting estimates at the gates. The estimates are formulated based on the referring veterinarians findings and suspicions. This estimate is based on many possible scenarios and presumed diagnostics, with presumed treatment plans. All of understand that this is difficult to cement into a narrow dollar figure. What it costs most clients is the fearful restraint that a large dollar figure, a potentially looming poor prognosis and the healthcare plan starting out, and being presented with financial influence at the welcome mat is both unkind, uncaring and costing care we can in all and every case negotiate and compromise. It seems, with all of the recent cases that we have sent, that the gates ability to open rely on the opening estimate. How can a learning institution practice medicine to train its students who will provide care to all kinds of clients with the admission set at worst case?. If they truly want to provide all clients options and follow the standards we were all taught, then these estimates have no place in greeting clients and patients BEFORE they are seen.

I have been a private practice veterinarian and practice owner for 20 years. There has never been one case that we have not helped in a manner that doesn't put the patient first, and the client feeling as if they are the at the center of everything we do, and that every patient has a team based approach.

There are many points of Jenn's letter that I understand as a veterinarian that are harder to explain to a client. The timeline. A clients idea of the passage of time is very different from the veterinarians. While I try to stay on time, Keep every client apprised of the time I am taking and explain/excuse why it is taking so long. It is inevitably impossible to be able to complete a complicated case, with all that we have to do, discern, digest, diagnose and report. Time in the clinic, on the floor, with a difficult case seems like seconds while the client is sitting for hours. We are always. always running behind, over extended, and never is there a moment where we sit down, relax, or eat, drink, or even pee. I will give them the time frame. I empathize.

The idea that any of us read every piece of paper, every diagnostic, each step another vet has taken, well, in reality we don't. We don't have time. And, after all, everyone, every other vet is is a charlatan. Don't waste your time reading over some half-wits work,, they couldn't figure it out, why waste your time looking at what they did.

No, what really lights me up is that they treated her like she was just another client. Just another replaceable mom, with another dying pet. She is a mom who loves her dog. She is the client we all worked so hard to get into vet school so we could take care of. She is the medium of all of our dreams. She almost walked out because they couldn't/wouldn't see her past their estimate. What an utter failure to even attempt to be anything of value. It doesn't matter what you are capable of if you cannot remember why you are here.

I welcome an open dialogue with UPenn, every ER, and every person who seeks help for the pets they call family. 

Please share your story of your pets care at Pawbly.com storylines section.