Recently there was a VIN post apparently referencing the content of one of my LEAP topics last year. The specific item in question was related to when you can fire a client and sever the VCPR. This is one of the most common questions asked at LEAP training events. As a result I’ve written multiple articles, including in the GVMA publication “The Georgia Veterinarian” on the topic, as well as gaining feedback from board members on the topic.

Although I think VIN is an excellent resource for veterinarians on medicine, I don’t find on-line posting forums a particularly prudent place to gain legal advice, (any more than self-diagnosing on WebMD or VetMed is the advisable approach) and as always encourage veterinarians with questions to seek competent legal advice from attorneys licensed to practice law in the state in which they practice veterinary medicine, in this case… Georgia. An out of state attorney providing advice on laws in the state of Georgia to a person in Georgia would be unethical and against the GA legal practice requirements, and I would urge Georgia veterinarians to carefully verify that an attorney providing legal advice on a legal question related to veterinary practice in Georgia is in fact qualified and licensed to practice law in the state of Georgia.

As to the specific question, the paraphrased version is that according to LEAP training, a vet is only able to fire a patient for non-compliance, even if physically violent to the staff. Apparently the take-away is that one must hope that a client become inactive for 12 months and then refuse to re-establish the VCPR.  This is an unusual take-away from Leap training, perhaps based on a partial portion of the section that covers the VCPR. As a result, the fine folks over at VIN have asked for some clarification.

From the Article in the Fall 2017 Georgia Veterinarian, I said

“There are a lot of easy cases where ending the VCPR and refusing further providing of veterinary services is the right thing to do. If the client is being threatening, stealing, breaking the law, refusing to pay bills, is clearly abusive or creates a danger to your staff, the animals, or other clients, then by all means refuse services. If you do not have the skills, the ability, or the proper equipment to provide the services, you should refuse services.”

So.. to restate the relevant portion, if you or your staff are in physical danger, subject to assault or battery, or other criminal activities from a client, I would urge you to call the police and sever the VCPR. I would note that in that event, the VCPR states that the client will follow the vet’s instruction, from the new practice act –

• GA 43-50-3-(15) ‘Veterinarian-client-patient relationship’ means that:(A) The licensed veterinarian or his or her licensed designee has assumed the responsibility for making medical judgments regarding the health of the animal and the need for medical treatment, and the client (owner or caretaker) has agreed to follow the instruction of the licensed veterinarian;

I’m not certain that the client (owner or caretaker) would be instructed to physically assault the staff, or even verbally abuse the staff… and there is a plain reading here that they have breached the VCPR through their actions. Regardless, the board has been clear and consistent that they do not expect a veterinarian to continue to provide veterinary care to the animals of abusive or criminal clients. So rest assured, a client not only threatening you, but stealing, damaging your clinic, or otherwise behaving in a manner that does not follow the “acceptable behavior” policy could be seen to be out of alignment with GA 43-50-3 – (15).

Also, in general, the VCPR is about when you *can* provide prescription medication and perform veterinary medicine on a particular patient of a client.  We have, at our clinic, encouraged or directed clients to seek alternative care, including enabling to do so with records and helpful recommendations/transfers.

Now, having said that, before you run off and fire all the clients you don’t like, there are some situations where by law, ethics, employment contract, or good business sense, you either should or must continue to treat an animal.  Here are a few examples of those types of situations –

IF  you refuse service to a person, where your business is open to the public, on the basis of race, color, religion, national origin, sex, age, veteran status, citizenship, disability or other protected classifications you are likely violating federal or state laws, including the Federal Civil Rights Act and/or the Americans with Disabilities Act. The mere appearance of refusing service on that basis may damage your reputation and that of your clinic, or put you out of business or a job.

Firing mid-treatment is unadvisable and cannot be done where it would violate the minimum standard of care in Georgia, or your ethical obligation to do no harm. You obviously can’t stop services while the patient is under anesthesia or where the health of the patient is at risk.  Reach a prudent transition point, and if you don’t have the proper skills or equipment, refer the client to another who can provide appropriate service.

When you do decide to refuse service on the basis of poor customer behavior, decorum or other legitimate, non-prohibited business reasons; take the time to consider whether it is advisable to do so.

A major source of liability exists if you do not consistently apply the same rules to refuse service. You may be considered to have violated those same federal laws we just discussed.  For example, if you only refuse service to people over 60 because they are ‘difficult’, the courts have rules in similar cases that you have engaged in age discrimination and could be liable for significant damages. Disproportionate refusals based on race, religion, sex or other categories leads to similar federal law violations.

Consider whether the client has reasonable access to other care. Will refusing care  cause an immediate harm to the animal? What if your service is subject to a Federal or State Grant to provide services to an underserved area? We have several of these grants in Georgia, and the rules regarding choice of client may differ when you accept such governmental or charitable grants.

If you are under an employment contract, your employer, rather than you, may determine which clients you may see, and your choice may be between continuing employment or refusing to see a particular client. There are significant ethical and practice act implications depending upon how and who is directing you to provide care that are beyond the scope of this blog post.

If you or your receptionist encouraged them to come in to have their animal seen, and then you refuse service when they arrive, be aware that you may be liable for damages under a claim of detrimental reliance.

Be careful if you deny service because they have a bad aroma, have a scary appearance, use inappropriate language, are cantankerous, or challenge your professional opinions. Clients rarely choose the time their pet has a health issue. Consider whether you want your clients to delay care to their animal so they can get appropriately attired to meet your standards, to delay treatment to their critical animal health issues because they are feel they’ll be viewed negatively for their English skills, their family, or even their choice of vehicle. Consider whether you will gain the reputation of ‘judging’ your clients.

No one wants to be judged when coming for professional help. And once the reputation of your clinic is that you are judgmental of clients, you will deter clients from seeking the care that their animals need. Indirectly if we discourage clients to seek care for their animals, we are ethically responsible for  harm caused to animals because of that. Veterinarians are licensed under the practice act for the benefit of the public, and unless there is a very important reason, deterring the general populace from seeking proper care of their animals does not follow those principles.

Working with the general public is challenging, and no one gets along with everyone. Clients may be stressed, emotionally vulnerable, financially challenged, and potential health issues of their animals exacerbate all of those emotional states. Compassion is hard when clients are rude, hostile, difficult, or just a ‘pain.’ They may have just come from a break-up, a funeral, or an argument over finances with their family. You don’t choose their state when they come in, but in many cases they don’t either. They have chosen to care for their animal even when they aren’t at their best.

Regardless of your choice, I encourage you to think of the best interest of the animal and client, as well as your comfort in serving the general public. Very few businesses open to the public get to choose only the nicest people to do business with, as any retail, restaurant, or other professional will tell you. Carefully consider the consequences of denying service to your clients… and let’s get better together.