Considerations before Firing a Client

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.



Posted in Small business | Leave a comment

House Bill 956 – Updated Georgia Practice Act.

We’re all, I’m certain, interested in how the law affects the practice of veterinary medicine, particularly in Georgia.  Below is a brief summary of some of the topics covered in the act, that we’ll be discussing on this blog.

New Practice Act for Georgia as of April 2018

House Bill 956 (As Passed by Georgia House and Senate)

After significant discussions and changes, the current house bill, sponsored by the GVMA, Representatives Pirkle, McCall, and Jasperse, and currently in front of Governor Nathan Deal for signature.

The impacts and descriptions are generalizations, and readers are encouraged to look to the actual language of the Act to discern the true impacts and changes of the updated Practice Act. Also note that ‘Vet’ is short for licensed veterinarian, and ‘Vet Tech’ is short for licensed veterinary technician.


Topic Category Section Impact
Food Animals 4-1-7 Law enforcement will check with vet prior to filing  criminal charges related to conduct with food animals.
Records-Confidentiality 24-12-31 Waiver of liability for disclosure of client records, if at direction of court or client. No requirement to disclose except for Rabies history to physician of person bitten by such animal, within 24 hours of such record request.
Purpose of Act 43-50-2 New guiding principles of Act are to (i) Promote, Preserve and protect public health, safety and welfare; (ii) uniform scheme of enforcement; (iii) provision of oversight of practitioners.
Definitions 43-50-3 New Definitions for – (see below for numbered definition changes) Animal, Animal Patient, Approved Provider of Continuing Education, Client,  Complementary, Alternative, and Integrative therapies, Consultation, Continuing education, Direct Supervision, Extra-label usage, Food Animal, Immediate supervision, Indirect Supervision, Informed Consent, Livestock, Mobile Veterinary clinic, PAVE certificate,  Practice of Veterinary Medicine, Practice of Veterinary Technology, Veterinary-Client-Patient Relationship, Veterinary Emergency Coverage, and Veterinary Feed Directive,.
Veterinary Practice (3) Animal  now includes any non-human animal (living or dead).
Veterinary Practice (4) Animal Patient – now includes groups of animals, threshold is examination or treatment by licensed veterinarian.
Animal Shelter (5) Animal Shelter – limited to those providing shelter and care for *homeless* animals.
Continuing Education (7) Approved Provider of Continuing Education – determined by the board, may be an individual or entity.
Veterinary Practice (9) Client – engages services of vet, for care, of an animal within their scope of control, as owner or caretaker.
Veterinary Practice (10) Complementary, Alternative, and Integrative therapies – broader definition, acupuncture, acutherapy, acupressure, homeopathy, manual or manipulative therapy, nutraceutical therapy, and phytotherapy now governed by the board when used on animals.
Telemedicine (11) Consultation – “act of licensed veterinarian receiving advice in person, telephonically, electronically, or by any other method of communication from a veterinarian licensed in this or any other state or other person whose expertise, in the opinion of the licensed veterinarian, may benefit an animal patient.
Continuing Education (12) continuing education – clarified that it is for benefit of practicing veterinary medicine or technology.
Veterinary Practice (13) Direct Supervision – same premises as animal, for treatment, must be quick and easily available.
Veterinary Practice (15) Extra-Label Usage – defined and now part of practice of veterinary medicine explicitly.
Food Animals (16) Food Animal – an animal raised for production of an edible product.
Veterinary Practice (17) Immediate Supervision – Oversight by licensed vet located in the immediate area, and within audible and visual range of the animal patient and the person treating the animal patient.
Telemedicine (18) indirect Supervision – oversight, not required to be on premises but given oral or written instructions for treatment and is readily available by telephone or other forms of immediate communication.
Veterinary Practice (19) Informed Consent – presented treatment options, reasonable efforts to inform client of the diagnostic, treatment options, risk assessment, prognosis, which are appropriate and probable – subject to standard of care – veterinarian agrees to provide and client consents to have performed.
Livestock (21) Livestock – animals converted to tangible personal property for sale or consumption (excluding domestic pets or companion animals).
Veterinary Practice (22) Mobile Veterinary Clinic – limited to units where animals are treated inside the unit.
Temporary License (23) PAVE Certificate permitted.
Veterinary Practice (25) Practice of Veterinary Medicine – Now expressly includes complementary, alternative, and integrative therapies and rehabilitation.
Vet Techs (26) Practice of Veterinary Technology – defined to include performing animal patient care or other services that require a technical understanding of veterinary medicine on the basis of instruction from a vet, excludes diagnosis, prognosis, surgery, prescribing, or dispensing. Include use of titles or representation that a party is able to do the above.
Veterinary Practice (29) Veterinary Client Patient Relationship – Now requires informed consent for any services. Follow-up now expressly includes other veterinarians and arrangement of care, as long as records provided during normal business hours. VCPR requires creating and maintaining appropriate records.
Food Animals (32) Veterinary Feed Directives – mirrors FDA recommended language for VFD.
Board voting 43-50-20 Quorum defined as a majority of board, veterinary faculty can be on the board.
Powers of enforcement of Board 43-50-21 Inspection powers, including of mobile clinics expanded, requirement to establish and annual publish fees for licensing.
Employment by non-veterinarians 43-50-30 Broadens of restriction of entities directing medical decisions or judgements.
Applicant Requirements 43-50-31 PAVE added to list of acceptable requirements (accreditation now established by AVMA. Applicants denied must be given notice with grounds, and right to a hearing with the board.
Licensing Examination 43-50-32 Board sets frequency of exams, no limit (used to be 3) on number of times an applicant can take an exam.
Continuing Education 43-50-40 Board may now waive CE for active duty military, for any period of time (formerly 3 yrs. or duration of national emergency). 10 hours of CE per biennium established in act for veterinary technicians.
Enforcement 43-50-1 Power to suspend license expressly granted in act.
Unprofessional Conduct 43-50-41 Fraudulent, misleading, or deceptive advertising includes representations on qualifications of veterinarians.
Temporary License 43-50-42 Temporary licenses may be given to military spouses as well as service members.
Temporary License 43-50-43 Faculty license practice broadened, now limited to institution of higher learning or educational or research program outside (but associated) with the institution.
Temporary License 43-50-44 Able to practice- faculty, resident, intern, graduate student of vet. School or vet technology – regular clinic/non-clinical functions, lecturing, demonstrations at accredited school with CE course. Graduate of ECFVG or PAVE under direct supervision of licensed veterinarian. Livestock management now includes “food animals”.
Telemedicine 43-50-44 Out of state veterinarians prohibited from “offer through electronic means remote services within this state, except for consulting, as otherwise permitted in this chapter.
Feed Directives 43-50-44 Feed directive requirement further limited per FDA guidance.
Owner’s rights 43-50-44 Owner can use bona fide, rather than full time employees. Ownership transfer to circumvent practice act called out.
Shelter care 43-50-44 Shelter care – under supervision of veterinarian, must be employee, written protocol from vet, properly trained. Does not include diagnosis, prescription, dispensing, or surgery.
Veterinary Medicine 43-50-44 AI now expressly part of veterinary medicine
Vet Techs 43-50-44 Vet Techs and other employees under direction of veterinarian, who is expressly responsible for their performance/acts.
Consultants 43-50-44 Added other providers/experts who in opinion of veterinarian would benefit animal, under their supervision and direction with valid VCPR.
Vet Practice 43-50-44 Farriery is for the “care of hooves and feet of equines and livestock.”
Temporary License 43-50-44 State of Emergency law link to allow out of state vets in certain circumstances.
Temporary License 43-50-44 Temporary license for institution of state’s institution of higher learning – must be for six months of longer duration.
Unprofessional Conduct 43-50-45 Unlawful practice including holding out yourself as licensed if you are not.
Licensing Examination 43-50-53 Applicants can take the exam more than three times without board review.
Vet Techs 43-50-55 No limit on number of vet techs at a practice.
Vet Techs 43-50-90 Vet Techs now expressly can be investigated by the board.
Board Powers 43-50-110 Broad powers – “necessary for the enforcement” of the act, including express powers to create additional rules necessary and reasonable to implement and effectuate the Act.
Posted in Small business | Leave a comment

Fantastic Audience at University of Georgia

I recently had the honor to speak at the University of Georgia on the legal aspects of Telemedicine. They have a really top notch faculty and facility. This was also one of the first places in the state where the impact and requirements of HB 956 (The new practice act) were discussed in any depth.

Look on this site for more blog posts on the act over the next few weeks.

Posted in Small business | Leave a comment

Great Days at the GVMA Fall Convention

I’ve just returned from the GVMA Fall Convention in Atlanta, Ga. After speaking to the board on Telemedicine and the Georgia Practice Act on Friday, I had the pleasure of hearing a full day of presentations on Telemedicine on Saturday (including Charlotte’s engaging presentation). Sunday I advised the foundation (which I recommend donating to… they do some great charitable work here in Georgia –

I received a number of very interesting questions, which I’ll answer here over the next few weeks. The majority are regarding telemedicine, and I’ve got an upcoming four part series on it for you that I’ll start posting.

On October 30th I speak in Columbus, GA to the CVVMA on the Top Ten Questions Veterinarians ask about the practice act. If you are in the area, come get 2 hours of LEAP and we’ll get better together!

On t

Posted in Small business | Leave a comment

New article in The Georgia Veterinarian

I’ve recently been published in the Georgia Veterinarian fall edition. The article, “Should you fire your client”  which covers some of the most common legal, business and ethical issues with terminating a client relationship. There’s a preview below, but for the full article go to, and I highly recommend you become a member.

“When you establish the veterinary-client – patient relationship, you agree to assume “the responsibility for making medical judgments regarding the health of the animal and the need for medical treatment.” GA 43-50-3-(15) And that’s great, but there are times when you don’t want to continue that relationship… and almost no vet promises to be a client’s vet for better or worse, in sickness and health…forever…”

Posted in Small business | Leave a comment

Questions from the Animal Law Symposium

It was a lively and engaging group of attendees at the Animal Law Symposium. So much so that we only got through 3 of the top ten legal questions for vet practices.  A couple of the questions that we will follow up with a blog post here include:

1) Is veterinary information confidential? Covered by HIPPA?

2) When do I have to report suspected animal abuse?

3) If a pet has been adopted out, what rights does the former owner/shelter/breeder have to direct medical care?

AND the most discussed topic, brought up by a member of the Georgia Board of Veterinary Medicine who was attending,  could be summarized as follows:

“When do I have a right to refuse care, or to refuse to provide services to a patient/owner?”

I’ve written on this last one before in GVMA periodicals and some other sites, so expect a fairly lengthy blog on this topic.



Posted in Small business | Leave a comment

Speaking at the Animal Law Symposium at the State Bar Offices

I’m speaking today to a packed house of veterinarians, animal control officers, attorneys, police officers, judges, and shelter teams. It’s amazing what Claudine Wilkins and Jessica Rock, including their many sponsors, have put together. A sold out legal education on animal law? Standing room only? Amazing.

For those who miss my “Top Ten Legal Issues for veterinary clinics”, I’ll be speaking on it again later this year.
I’ll post answers to questions they pose, as always.

Let’s get better together!

Posted in Small business | Leave a comment

A Recap of 2016

Hi all,

As 2016 comes to a close, there are still about 4 unanswered questions in the inbox. Rest assured I have posts coming for them next year.  One of the items I have been eagerly awaiting is the January meeting of the Board of Veterinary Medicine. Additional rules or suggestions for clean-up to the practice act have been discussed, and they may change some of the ways that veterinarians practice medicine or keep records. Or things may stay entirely the same. Stay tuned.

To all my kind readers, may you have a marvelous new year.

And in 2017, let’s get better together.


Posted in Small business | Leave a comment

What’s my liability if my client doesn’t follow my advice?

P from Georgia asked the question “I am currently treating a dog with demodectic mange. The dog has not been spayed as the owners are considering breeding her despite my recommendation that she be fixed. Am I liable in any way if I continue to treat this dog (for her own well being) and she goes on to have demodex-affected puppies?

Great Question. We all have clients who do not follow our recommendations.

There is no specific additional liability to continuing to provide care at least to the level of the standard of care required by the Veterinary Practice Act. In Georgia, that means it must be above the minimum standard of acceptable and prevailing veterinary medical practice (GA 43-50-41 (6) ).  You must also continue the VCP, which means they must have agreed to follow the instruction of the licensed veterinarian. (GA 43-50-3-(15)).

Typical cases of professional liability require a duty, a breach of that duty, and damages resulting from that breach. As a professional, your duty is held to the higher standard of your profession, which I listed above. You only have that duty if you have a VCP, and it appears they did agree to follow your instructions, although you are working out portions of that. I would not interpret the VCP to mean they have to follow every recommendation or option presented, but rather generally to follow your instruction on care and not refuse all options presented. That’s just my reading, but it seems to match most Veterinary Medical Board’s interpretations of that clause.

Assuming that you had a duty, and you breached that duty by not following the professional standard of care, what are the damages of Demodex Affected Puppies? Assume you did not warn the owner of the risk. Then you may, and I do mean *may* because I am not an expert on veterinary medical standards for Demodex, have breached your duty of care. If you did, then typical damages might be veterinary expenses, the difference in value from demodex affected puppies and non-demodex affected puppies, and with a generous ruling, perhaps incidental expenses. Unless these are really rare breed puppies, it should be a relatively small liability, and it’s the type of claim that PLIT or a similar professional insurance typically covers (subject to insurance policy exclusions for things such as intentionally giving poor advice.),

But what does this all mean for us? It means you have very low risk of liability if you follow the standard of care with a properly established VCP. This ties back to the ethical requirement of “do no harm.” I’d certainly document your advice, and provide clear warnings to the owner. I’d also outline your protocol of diagnostics care for the potential litter, if they have demodex-affected puppies. Providing well documented education and advice on the consequences of refusing recommended care is important to help show how you meet the standard of care, as is providing options for care if your primary choice is rejected.

Thanks for the great question.

Now let’s get better togeterh.


Posted in Small business | Leave a comment