Complaint over Winnipeg veterinary hospital's fees, communication leads to professional misconduct finding
'I wanted to have my pet back, so I paid the bill,' says owner who took dog to hospital in 2021
When Chris Cymbalisty took his dog to a Winnipeg veterinary hospital for respiratory distress in June 2021, he didn't expect a bill for almost $4,000 and a dispute over the care provided and costs that's still ongoing 18 months later.
Cymbalisty, who is an emergency room physician, filed a complaint with Manitoba's veterinary regulatory body about his dog's care, which led to a finding of professional misconduct against a vet who is an owner of the Bridgwater Veterinary Hospital and Wellness Centre.
He took his dog Zeus — a 10-year-old boxer mix he describes as a "docile, big, loving teddy bear kind of a dog" — to the Bridgwater Veterinary Hospital in June 2021, when Zeus was having breathing problems.
The dog was diagnosed and treated at the hospital over the course of five days, but Cymbalisty says he could not get answers to his questions about the care provided and the costs.
"I was completely dismissed … from the very start," he said in an interview with CBC News, adding the treatment "was absolutely … infuriating."
On the first day, the dog was examined and then had a tube inserted into his trachea to help him breathe.
On the second day, the vet hospital released the dog. But before Zeus even got home, Cymbalisty discovered the health issue wasn't resolved. The dog was taken back to the hospital and had to be reintubated at significant expense — about $700.
Around 5 a.m. the next day, "I received a call saying we either have to reintubate him again, [for] a third time in 48 hours, do an emergency tracheostomy — which is … putting an airway through his trachea — or euthanize him," Cymbalisty said.
Cymbalisty opted to leave Zeus in care, and his condition improved over the next few days. The vet bills for the five days added up to about $3,900.
Hospital failed to answer questions, owner says
Cymbalisty says staff at the vet hospital failed to answer his questions about the care provided to the dog, including his belief he had been overcharged. He said he asked about the calculations involved in medication fees during Zeus's hospitalization.
"I had some questions regarding some of the dosing of medications that I just didn't understand. They were massive quantities of some of the medications used, and I just wanted some clarification. And no one would speak to me during this time to clarify those," Cymbalisty said.
He also said he was not given a written prescription for medications so that he could potentially buy them at a pharmacy. As well, Cymbalisty said he has questions about why the overnight vet at the hospital digressed from the agreed-upon treatment plan.
Another issue came up when he went to pick Zeus up after the five days, he said.
"I said … 'I have some issues about the care that was provided and I'd like to discuss with someone.' And they said, 'Well, there's no one here to answer any of your questions and you can't have your dog unless you pay your bill in full,'" said Cymbalisty.
"I wanted to have my pet back, so I paid the bill."
He was told to phone for information the next day, but "that started a four-month engagement with their customer representative that went absolutely nowhere," Cymbalisty said.
Professional misconduct: MVMA decision
Last year, the Manitoba Veterinary Medical Association passed a bylaw that says a vet cannot refuse to return an animal, or its remains, to its owner for failure to pay fees owed, but that bylaw was not in place when Cymbalisty took Zeus to the hospital.
After failing to get his questions answered, Cymbalisty filed a complaint with the MVMA in October 2021.
A decision delivered a year later — which Cymbalisty is appealing — found a veterinarian and shareholder of Bridgwater veterinary hospital had demonstrated professional misconduct.
The November 2022 decision from the veterinary association's complaints committee said that Dr. Michelle Cutler "demonstrated professional misconduct in her role as shareholder … in her failure to ensure adequate client communication was provided by the veterinary team, and, ultimately, her own refusal to engage with Dr. Cymbalisty."
Cutler was not directly involved in Zeus's medical care at the hospital, but the regulatory decision said she was responsible for making sure her staff had "adequate informed consent and create[d] reasonable confidence in a patient's care."
"I am disappointed in the response by the MVMA regarding the case brought against Bridgwater and the staff, and myself as managing director," Cutler told CBC in statement.
"Although I do not feel the MVMA listened to the responses of all the parties involved, I strongly believe in [a] client's right to make a complaint with the regulatory body."
Cutler identified herself as the national medical director at VetStrategy, a company that operates more than 360 veterinary hospitals and practices across Canada. She also acts as managing director for those clinics, including Bridgwater.
The decision also identifies Cutler as a shareholder in VetStrategy Manitoba Veterinary Corporation, which has an ownership interest in the Bridgwater animal hospital.
Operating procedures to be reviewed: agreement
Cutler said the Manitoba veterinary association's findings will prompt changes at her company, including "updating our operating procedures to ensure clear lines of communication are followed to ensure the best patient care possible."
To settle the investigation into Cymbalisty's complaint, Cutler entered into an agreement with the veterinary association's complaints committee, which requires her to update or confirm the written standard operating procedures for Bridgwater Veterinary Hospital by June 30, 2023.
That review is to look at six issues, including giving the client a written prescription for any medications, communicating with the client on the "major differences in calculation of human medical and veterinary fees," and communicating diagnostic test results to the client, the decision says.
It should also address communication with clients on veterinary resources and patient status, on fee payment when a patient is discharged, and on answering questions or complaints from the client within 14 days of a patient's discharge.
Cutler is required to review the operating procedures with full-time hospital staff by next June.
She has also agreed to take six hours of continuing education focusing on veterinary client communication, the decision says.
But Cymbalisty says the decision doesn't address several points he raised, so he's appealing it.
"I think there's some acknowledgement … that my concerns were validated in some ways," he said.
He's still unhappy with the way the veterinary hospital staff treated his case.
Cutler declined to comment further while the appeal is underway.
39 complaints in 2021
MVMA registrar Corey Wilson says the association cannot comment on any specific complaint it receives.
He did say the length of time needed for an appeal depends on the complexity of the case and the current caseload, but the committee aims to complete cases within nine months.
Except for urgent or emergency care, Wilson says the veterinary association's regulations require veterinarians to give clients a fee estimate before providing service.
"If a client has any questions about the estimate, they should ask their veterinary professional for additional information about the estimate," he said.
The fee disclosure "must be made in a clear and understandable manner" before the services are provided, the regulations say.
Wilson points out the MVMA does not set fees for veterinary practices, but a spokesperson for the province says the association has a recommended fee schedule for veterinarians as a guideline for pricing. That document is not publicly available.
The decision in Cymbalisty's complaint has not been published on the MVMA website, and according to the association's rules, it would not be shared with veterinary regulators in other provinces because it has not been published in Manitoba.
In addition to her Manitoba registration, Cutler is registered as a veterinarian in other provinces such as Ontario, Saskatchewan and Alberta.
Wilson said the MVMA opposes media identifying the veterinarian in the complaint because the case was resolved through the agreement Cutler made with the complaints committee, without going to a public hearing where evidence is tested.
Cymbalisty's complaint was one of 39 formal complaints submitted to the MVMA in 2021. Of those, 23 cases were dismissed by the complaints committee that year.
As for Zeus, Cymbalisty said his dog eventually died months later from renal failure, which was unrelated to the initial issue that prompted the trip to the veterinary hospital.
"Fortunately, after discharge, we did not have a single episode. He lived for another eight months," Cymbalisty said.
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