Value Vet-Repost

This is a repost as someone tried to pull a fats one to have google automatically delete this post. 

Many of you know I have championed Value Vet during the past three years as an excellent provider of veterinarian services, including the Department awarding it the West LA spay/neuter contract against some opposition.

I first went to Value Vet three or four years ago where I met Dr. Feldman, who was always gracious, had a great bedside manner and provided quality veterinarian care at a budget price. In my estimation Dr. Feldman provided care at about a 30+% discount compared to other vets in the West Valley area.

However, things have changed. Since the City awarded Value Vet the West LA spay neuter contract, and since VV performs a large number of spay/neuter surgeries, VV now has a large, City-sponsored and supplied captive audience.

It appears that Value Vet is taking advantage of this City captive market and has moved from supplying excellent care at a discount, to providing ever more ambitious care at a much higher prevailing fee rate, however, without the staff to safely supply these procedures.

My recent experience with the Canoga VV has been a nightmare, with a rescue cat receiving a 45 minute abdominal exploratory surgery on Friday afternoon, and being left unattended, while receiving fluids on an IV drip for four days, sometimes being unsupervised, unmonitored and unfed for up to 19 hours at a time. She was not given pain medications on the second day. None of the two weekend veterinarians was asked to look at her to see how she was doing. She did not eat for 4 days, yet no one attempted to syringe feed her.

I have asked around for professional opinions and universally they say no cat having received major surgery and while on an IV drip should be left alone beginning three hours later, for 15 hours until the morning staff came in. The next day she was left alone at night, unmonitored for 16 hours, and Sunday evening for 19+ hours. This is not an acceptable level of care for an animal having received major surgery.

My experience in summary:

The fees at Value Vet are no longer a value as in the past. For all intents and purposes their charges are the same as those at VCA or other large multivet clinics that have huge overhead in terms of large facilities, large numbers of very expensive diagnostic and treatment equipment, large staffs, near round the clock veterinarians on duty, as well as night vet tech staff.

The Canoga Value Vet does not have a round-the-clock staff to monitor animals overnight and the physical plant itself is miniscule and chaotic with huge potential for medical mistakes.

My cat Lakshmi spent a total of 5 days during two hospitalizations, including 4 after major surgery, on an IV fluid drip without a night staff to monitor her health. Why I allowed this I do not know. I put her life at risk by letting her be without medical supervision for as many as 19 hours at a time. The surgery was Friday afternoon, and the clinic closed at 6 pm, leaving her alone until 9 am Saturday morning, and then again from 2 pm on Sunday to 9:00 on Monday morning.

The total cost of treatment was essentially the same as if I had taken her to a specialist, given a far less intrusive endoscopy with biopsy, rather than the long abdominal exploratory surgery she did have, followed by 4 days and nights on an IV, totally alone at night. Yet, I was told since I had such a long relationship with VV and they had treated several pets in the past, I was given their top, lowest priced, best discount. This leads me to ask how much are they charging to the general public who now comes mostly as a City referral?

On the weekend, she was locked in a single bank of cages, next to very noisy cages with lots of frightened dogs kep before and after S/N surgery of animals referred by LAAS. The room where she was caged is also the surgery prep room, is incredibly small (maybe 80 sq ft) and therefore very crowded with the cages, the animal preparation area, people going in and out of the bathroom, or in and out of surgery attached to that same room carrying comatose animals to cages. On week ends, due to all the business the City of Los Angles sends their way, there are many spay/neuter surgeries and the animals recover or await surgery in the same bank of cages she was in. That little room is chaotic and rife with the possibility of medical treatment error.

Lakshmi was never looked at by a weekend (Saturday and Sunday) relief vet until I insisted on Sunday. The vet with a Russian sounding name told me on Sunday (the surgery was Friday afternoon) no one had told him he should look at Lakshmi, the only cat that was there when he arrived, and who had been there in a cage, on an I.V., for two days following major surgery. Why he had not been asked to check on her condition as part of his duties on Sunday points to some sort of communication problem within the clinic.

Dr. Sherif Abdelmalak did not see Lakshmi until Monday morning, 2-1/2 days after the surgery, despite my telling staff on Sunday that Lakshmi was not doing well. She had not eaten since surgery on Friday. She subsequently vomited 4 different places in her cage between 2 pm on Sunday and 10 am Monday morning.

When I came on Sunday to see her, they were already closing up early (2 pm) and I found to my utter shock and depression that Lakshmi had not had any pain medication that day---the second day after major surgery. I finally demanded she be given pain medication.

I was told by staff that Dr. Abdelmalak had stated pain meds were only to be given on Saturday, because the pain meds could mask her symptoms. But so what? No vet looked at her on the weekend, and she would be alone in the cage for an additional 19 hours from Sunday at 2 pm to Monday at 9 am. What good did it do for her to be in pain, alone for over 19 hours so that no one could see whatever symptoms she was having, and Abdelmalak didn’t think not eating for 2 days and frequent vomiting was worth a visit by him.

In fact, on Saturday I saw the note on her cage that said she was to be given pain medication on Saturday only. I asked Tony (office manager) if the pain meds were only going to be given on Saturday as the note said, and why none were prescribed for Sunday. Tony said that those notes were for Saturday only, and certainly she would be given pain medications on Sunday and Monday. But they did not until I insisted on Sunday as they were closing. Rather than give Buprinex 2 X a day, it was given only once every 24 hours.

Dr. Abdelmalak was told by staff at my insistence at about 2 pm that she was not doing well. He made no attempt to come in and see her. He said there was nothing he could do but wait.

Lakshmi did not eat at all from the time of her surgery until I picked her up on Tuesday—4 days. Dr. Abdelmalak insisted she only be fed Science Diet i/d for abdominal symptoms. She did not touch i/d for 4 days. Apparently he thought it better for her not to eat at all than to eat anything besides Science Diet i/d.

Dr. Abdelmalak only once talked to me on the phone during the 4 days Lakshmi was in the hospital despite his promise to advise me of lab results and her progress. He talked to me that one time on the phone when I was in tears demanding she get pain medication on Sunday afternoon, and after I complained to staff that Dr. Abdelmalak never talks to me on the phone—he has others do it. Communication was never initiated by Value Vet. Never. Of course I did talk to him when I came in on Monday.

Later when I talked to him he told me his father had had a heart attack
That weekend and his personal life was in chaos. I can understand his viewpoint, but, at the same time, my cat’s life was in danger, she had no pain meds, she was not eating, and no attempt was made to syringe feed her. And, the weekend vets were not even told to look at her.

Value Vet closed at 2 p.m. on Sunday. She had not been eating so they left a small dab of Science Diet i/d on a small plate as her only food. On Monday morning, I waited until 10:15 a.m. to call to see if she had been eating. I had assumed they would have tried to feed her first thing since she had nothing fresh for 19 hours. Incredibly, Tony said they had not fed her yet, but they would “In about 15 minutes.” She went 20.5 hour without food.

On Monday afternoon I suggested feeding her something other than i/d, such as a/d, which she had eaten before. Lakshmi did not eat this either when offered. My feeing was it was because of under-treated pain.

Tuesday morning when I came to see her she had still not eaten. They had not tried any other food. It is my understanding that if a cat has not eaten in two or three days, it is better to get her to eat anything rather than just the “correct” prescription food. Dr. Abdelmalak stated he thought it better she remain the another day, as though she was not eating, she was still getting fluids and medication. I said no, I wanted to take her home. I had brought a can of Fancy Feast with me. Lakshmi wolfed down a half can in 15 seconds. I did not feed her any more at that time, but made arrangements to take her home several hours later when it was less busy. Tony and the doctor were both surprised and happy that she was finally eating.

Dr. Abdelmalak said the three sets of X-rays were very difficult to read and understand because they showed poor organ definition. He stated that the poor definition may be due to the presence of abdominal fluids or rampant inflammation in her belly. He did state he did not think it was fluid after palpation.

The oncologist I took Lakshmi to at VCA on January 8 (Dr. John Critin) stated the X rays were of relatively poor quality but clearly showed multiple organ enlargement, spleen, liver but especially stomach. He stated that Dr. Abdelmalak should have told me this. However, it was clear that Dr. Abdelmalak did not know this at all. He was perplexed by the results. Critin also said her heart was small and she had a heart murmur. Dr. Abdelmalak did not mention this either.

Regarding Lakshmi’s cost of treatment. When I first brought her in, a week before the surgery, Abdelmalak said because I was a long time customer, had been supportive of Value Vet and knew Dr. Feldman, I would get the highest discount, their very best prices. Instead:

Regarding prices, I believe 6 “administrations of meds” (over the 2 admissions) charged at $300.00 was excessive.

The Antech C1 blood panel was charged at $166.18, high average. VCA charged $165 and change.

The Fecal Combo Giardia test was $51.00, I think high normal prevailing rate. Fluids were $65, the same as VCA. Catheterization was $28, $20 less than VCA, and the office vistit was $20 less than VCA.

Additional Urinalysis was an additional $25.88, again, slightly lower than VCA.

The $500.00 charged for exploratory surgery was excessive in that I could have taken her to my own internal med specialist I’ve used before (Dr. Broome) for a far less invasive and painful endoscopy for $425.00. Biopsy, of course, was necessary in both cases. Dr. Abdelmalak never suggested referral to someone else for less invasive treatment, nor to defer surgery until after the weekend, when he would be the attending, or to take her to another clinic with a night staff. He did suggest I could take her to an emergency clinic after surgery so someone could monitor her at night if that made me more comfortable. However, that would have cost hundreds more. Apparently he did not think leaving her alone for 15-16 hours (Friday closing to Saturday opening) was a concern.

It was a concern of mine at the time, but the concern became extreme after I saw with my own eyes how she had been treated.

I was given an estimate for the exploratory surgery procedure and dental (we talked about the extraction of one tooth beforehand), and was shocked to hear an estimate of over $1,400. This was in addition to the well over $700 I had already spent. She was already in the back room being prepped and I had no idea if I could get her to see my usual internal med specialist (Dr. Broome) in Westwood in a reasonable time as an alternative. I did not know how sick she was so I thought immediate treatment was essential and gave in---extremely reluctantly. I found out later that Dr. Broome was out of town until the following Wednesday and I didn’t see much use in taking her to another general vet like Adler, which would have required an entirely separate workup and perhaps redundant testing, although Reimer may have been less aggressive or suggested an endoscopy. Nor did I know whether Reimer was available or what other doctor might be on call. Lastly, I had had 3 cats die while hospitalized at Reimer’s clinic in the previous 18 months, so I was not in a rush to take any other cat there. (Two kidney failures on fluids and one cat with exploratory surgery and cancer tumor removal.)

I asked Tony if I could get a discount, and Dr. Abdelmalak told him that this ridiculous charge already had a razor sharp profit margin, but he did give me a 5% discount.

After the exploratory of her belly, while she was still under, I was talking to Tony and he said Dr. Abdelmalak said she needed a dental and extraction, which would cost another $65, even though we had already discussed the dental need this prior to the estimate. I had assumed the dental was included in the quote. Of course I said yes. He also said a fecal culture was needed and that was another $114. I felt he had misinformed me with a lowball estimate or else he should have been more careful in preparing it and added in the dental. I learned afterwards that Tony may not have put the dental charge on the final bill. I am awaiting copies of all the bills as mine appear different from what the doctor said I was changed.

I feel I was given first world charges for what turned out, in my opinion to be third world care, with no night supervision for as many as 19 hours at a time while she was on an I.V., and no pains meds after Saturday until I insisted. I was deeply hurt, depressed and feeling guilty by what I put Lakshmi through as well as feeling I had made a fool of myself for going along with Dr. Abdelmalak’s treatment plan of exploratory surgery. I just did not know how sick she was, if I could see a specialist in a short period, she was already being prepped for surgery. I felt under pressure to make an immediate choice and chose for treatment despite misgivings as Dr. Abdelmalak indicated it was a medical necessity. Who am I to judge medical necessity? I still feel depressed and guilty almost two weeks after the surgery.

Given the extremely small size and layout of the Canoga facility, and given the volume of City-referred and funded surgeries taking place there, I fear for the quality of the care offered to these animals, and I wonder what is the final out the door charges are to new owners who are given essentially a free spay/neuter, but may end up paying substantially more.

If the bill I received and the care Lakshmi received was their premium best for a long-time customer, what is happening with the general public?

I think the Commission has to do due diligence in this situation as Value Vet is a City contractor, and investigate the Canoga premises as to the adequacy of the facility for high volume care of City adopted animals, and which treatment will reflect on the City with VV as a contractor.

I think the City should obtain a sample of the final bills given to adopters to check the fees and procedures.

I think VV should never be allowed to do a major surgery leaving an animal alone at night after major surgery, and especially while on IV fluids.

The biggest question in my mind is how could Value Vet go from being a good, solid discount veterinary providing quality services at substantially below market prices, until they get a City S/N contract, a rent free state of the art facility, along with no utility payment overhead, and then go to a VCA level of pricing offering services beyond their capacity to provide safely?


Lakshmi said...

Poor Lakshmi. Poor darling baby. What horrific pain, confusion and loneliness she must have suffered. Thank God she is no longer suffering, nor in pain.

Ed Muzika said...

Actually, Lakshmi is doing well now.

I took her to an oncologist at West LA VCA who put her on prednisone and Leukeran in January.

She now is ten months into her chemotherapy and weighs almost 9 pounds. She sits on a chair next to my computer and gets pets all day long.

She is absolutely gorgeous. The oncologist said he thought she'd have about a year to live after starting therapy. So, we'll see.

What Good News : ) ! said...

Oh, such good news! God bless Lakshmi! How often does she get chemo? Poor baby. I'm so glad she has gained weight and is back to her normal weight! Is she a white, long-haired kitty?

If it weren't for Kaiser, my husband would be paying $2000 a bag for the chemo he gets every three weeks, plus $800 a week for Epogen shots (not counting blood transfusions).

Did Lakshmi have to have blood transfusions and Epogen (Procrit) injections every week to increase her red blood cell count?

The little person who first alerted me to Epogen (for anemia) was one of my first abandoned strays here (Fatso). When Fatso had kidney failure, one vet put him on Epogen shots. Then my best friend came down w/ Chronic Kidney failure, and she is on Epogen. Then my husband. It helped increase their appetite for a time, until they either got better and they were off of it, or they didn't need the blood transfusions anymore and then got chemo. Both Cancer and kidney failure patients get Epo and it works wonders, until the chemo becomes enough as supportive care.

It looks as if Lakshmi is going to do much better than what the vet said. I hope and pray that both of our babies' veins are going to hold up w/ all the needle poking. Is the Leukeran oral chemo, or is it IV infusion?

She is doing amazingly well after 10 months of chemo and I am so happy for her. Sweet, sweet Lakshmi. I'll bet she loves all those all-day pettings on the computer. She's your computer secretary!

My thougts and prayers are with her. I'm so glad she is doing so wonderfully! What a sweet baby....

Ed Muzika said...

Lakshmi is doing well.

Leukeran and prednisone are both oral medications we have formulated at Valley Drug. She gets the pred daily, and 1.5 mg of Leukeran every other day. She has Persian length black hair, and is beautiful. She is not really in remission, but her cancer is under control. Her red blood cells are normal and she has never needed Procrit, although we have had cats in the past that did receive it.

Beautiful! said...

I'm so glad Lakshmi is on oral chemo. Thank Goodness! She has Persian length black hair? How gorgeous is that?!! Absolutely beautiful indeed! If you can, please post some pictures of Lakshmi. I'll bet lots of people would love to see them, including me! : )