? Should we withhold payment to boarding hospital?

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PhantomBanker

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TL;DR at bottom.

Our 10-year-old cat was diagnosed with diabetes a couple years ago. For the past year, we have been giving her 3u of Novolin N twice daily. This has been fairly consistent, and we haven't had any real issues or complications since.

Earlier this month, my wife and I surprised our daughter with a birthday trip to Disney World. We brought both our cats to a boarding hospital on Saturday 3/9 and flew down to Florida on Monday 3/11. We provided them with food and insulin.

On Monday evening, we received calls from the vet in charge: Tonks was experiencing seizures and was unresponsive. Her BG was 13. We approved additional care, including an IV of dextrose (sp?) to get her levels back up, but the clinic did not provide 24-hour care (only boarding). My mother-in-law drove up and brought her to an emergency clinic that was able to monitor throughout the night. The vet tried to be honest--he was worried our cat may be dying.

The emergency clinic continued the IV and administered anti-seizure meds. They wanted to run a whole battery of tests to determine why her sugar was as low as it was, but we asked they just try to keep her stabilized and we would make another determination in the morning.

The next day, we spoke with the day-shift doctors. Tonks did have another small seizure, but for the most part was alert and moving. The BG wasn't as high as they wanted (I don't have the exact numbers in front of me), but it was moving in the right direction. Over the next day or two, she started to respond better to the high-calorie foods (the IV was no longer "patent"--not exactly sure what means, but I'm guessing she kept trying to remove it herself). They still refused to give her insulin unless the BG got too high, which it never did.

She was returned to the boarding hospital for the remainder of the week. They continued the anti-seizure meds, checked her BG every four hours or so, and continued to hold off the insulin. We returned on Friday afternoon and brought her to her regular vet on Saturday for a checkup. They didn't run any tests (probably figured she's been poked and prodded enough) and just relied on the notes from the two clinics. She was to continue the anti-seizures but no insulin.

The following Thursday, her regular vet did a quick BG check, and she was over 300. We were to start giving her 1.5u of insulin twice daily, and slowly wean her off the anti-seizure med. We scheduled an appointment a few weeks later for a curve.

Here's the impossible question to answer: What happened to her, and to what extent can we hold the boarding hospital responsible? They were adamant that they kept to the insulin and feeding schedule and stated they would not have given it to her if they felt she wasn't eating enough. They even had a staff meeting just the week before in regards to boarding diabetic animals. While I'm willing to believe they wouldn't do anything to jeopardize the health of their animals, it almost felt like they were protesting just a little too much. The costs were much higher than the original estimate due to the additional treatments. We agreed to pay the boarding fees for the other kitty, but we didn't want to pay them for Tonks until we got her vet's input on what happened.

TL;DR: Cat had severe BG drop while on vacation. Was it something with the cat that was unavoidable, or did the boarding hospital make a mistake they won't admit to?
 
Given that her BG dropped to 13(!!), I would suspect an error on the part of a tech somewhere. Probably completely innocent, but a near-fatal error none-the-less. Unless they had surveillance cameras, it's something that would be practically impossible to prove, one way or the other. Unless you measured her insulin when you handed it over, and measured it again, then determined how much remained vs what should have remained after all administered doses were accounted for . . . and I'm thinking you probably didn't do that because why would you?

Sounds like an extremely distressing incident, and once I made sure the cat was all right, I think my blood would be boiling - but there's the off-chance that they did everything right and she just had a moment, one whose cause may never be known. If it were me, I think I'd bite the bullet, pay the bill, and try to put it behind me.
 
Afraid I have to agree with Erin & Scott with one caveat. Was the boarding hospital blindly administering insulin or were they testing BG before shots to ensure BG was high enough to give insulin? If they were testing, then there MIGHT be some evidence that they did not administer the insulin at a safe level of BG but then that would be something they would depend on you to provide in the way of care instructions.

Unfortunately, it's impossible for any boarding hospital to know if the food portions being eaten by a kitty in their care are the same as what kitty would eat at home prior to administering the insulin. It's possible your kitty was eating less or that the boarding hospital staff didn't feed your cat before giving insulin and the delay caused a severe drop in BG but all of that is just speculation for which I doubt you'd ever be able to get any proof.
 
It's possible your kitty was eating less...
Adding to this comment...
It's extremely common, more common than not, for kitty to eat much less than they normally do when their people are away. We see it all the time... so much so that we suggest a reduced dose for pet sitters of diabetic cats. Reducing the dose helps cut down on hypoglycemic incidents.

... and to what extent can we hold the boarding hospital responsible?
It is impossible to answer. I'm afraid you'd have to consult an attorney and they may conclude as the others did above.

Sorry, I/we haven't been of any more help...
 
the IV was no longer "patent"--not exactly sure what means
It just means that fluid will no longer flow through it. It can happen for various reasons, including if the IV catheter is left in, but capped, overnight with no fluid flowing through it. Heparin flush is used to try to prevent blood clotting within the catheter, but it's not 100% guaranteed by any means.

What happened to her, and to what extent can we hold the boarding hospital responsible?
Were they meant to be testing her or just giving insulin? If you hadn't requested that they test, they could reasonably have thought that you had advised them of a dose that you know to be safe without her being tested every day. You may never know for sure exactly what went wrong, but unfortunately with diabetes, and especially with a shorter acting insulin like Novolin, cats can simply crash pretty much out of nowhere. And a small number of cats will run lower BG rather than higher when they're stressed (I have one that does exactly that, even though it goes against everything we're told about stress causing spikes). So it's possible that she simply dropped in a way that no-one could have expected. If you had requested that they test on your schedule, including pre-shot tests, then you would of course want to see the test data to make sure they'd followed your instructions on when to withhold the shot.

And, can I also say, I'm really sorry you're having to go through this. I did have one bad experience with a boarding hospital that decided that my in-remission girl "should" be on prescription diabetic dry food, not the low carb wet food I'd sent with her. So that's what they fed her. They almost broke her remission with it - it took me a week to get her numbers back down. So I'm also reluctant to say that your hospital is blameless - it really depends very much on the exact circumstances.
 
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