Another week, another veterinary ER under fire. This time, it’s the Southwest Michigan Animal Emergency Hospital, now receiving angry calls and even death threats after declining to perform emergency exploratory surgery on a young German Shepherd who developed complications after a spay at a different clinic earlier in the day. The issue was the owner’s inability to provide upfront payment. It almost always is.

There is no doubt that this is a terrible and sad outcome for the owners of the dog, and I am utterly sincere in saying my heart goes out to them. As a result of going to social media, both the heartbroken owners and what is, by all accounts, a good emergency clinic are receiving heated scrutiny they probably don’t deserve. Here’s 5 things I wish everyone knew about this sort of situation:

1. This may be once in a lifetime for you, but it’s once in a shift for the ER.

Veterinary care, and emergency care in particular, is expensive. It’s not price gouging; it accurately reflects the increased cost of running an overnight facility with high overhead. Due to the nature of emergency work, there are a high number of large estimates, and a good number of people who say, “I can’t afford that.” Good people, and good pets. None of that changes the fact that the costs are fixed. Because they weren’t inflated with a “just because I feel like it” tax to begin with, there isn’t wiggle room to negotiate it down. If you do, you go out of business.

2. “I can’t” doesn’t mean “I don’t care.”

When the doctor in this story said “I’ll be fired if I don’t charge appropriately,” I’m sure she (or he) meant it. When I worked an ER shift as an employee, lowering cost equaled theft of services. If an audit found treatment in the medical record not on the bill, it was either added to the bill or came out of my paycheck. There are only three variables in this: the practice owner, the vet providing the estimate (who often is not the same as the owner), and the client. Someone pays that bill. There is no “make up for it through inflating insurance charges to the insured” option we see in human hospitals.

Saying no is really, really hard. People ask me to do things all the time that I cannot do. Just because I have to say no, doesn’t mean I don’t go home and cry about it sometimes. Don’t confuse lack of ability to give you something you want with lack of wishing I could. Vets talk about this struggle every day, and every day work on ways to ensure pets get the care they need without going under. That being said, there’s only so many times one can apologize for wanting to get a paycheck for doing work. Like most vets I know, I give away plenty of services and time, but no one gets to determine the how and why of that except me.

3. We don’t know why the dog died.

It could be a surgical error, yes. Spays are major abdominal surgeries. It could also be many other things having nothing to do with the surgeon. A genetic clotting disorder, for example, is something no one can predict and can absolutely cause death in a textbook perfect surgical procedure. Let’s say hypothetically that this were the case, that testing was done and it was something no one could have predicted or prevented. Then who would be responsible for the bill? Still the original vet? Do we need to know who is at fault before attempting treatment?

4. If you want to blame someone for vets not offering payment plans, blame the other people in the waiting area.

Most vets have toyed with offering payment plans at one time or another. Of course that would be preferable to turning someone away, if they worked. The pet gets treatment and the vet gets paid. If people followed through, payment plans would exist, plain and simple. Truth is, 80% of the fees are never recovered. It’s an unsecured loan to a stranger who, history has shown time and time again, is very unlikely to repay you. The more someone swears up and down that they are good for it, the less likely that is to be true.

CareCredit, the financing option many vets offer now, is admittedly a shaky proposition, though it’s often the best we got. It’s hard to qualify for and the interest rates are often over the top (26% after the introductory period in many cases.) I’m glad to see other options being tossed around- MedVetPay being one I’ve just recently heard about- but it’s not the vet’s obligation to provide financing. Still, we try. We want this to work for you, too.

5. Every pet owner needs an emergency plan.

“I didn’t know I needed $2,000 ready to go,” said the owner. Many people don’t. Know your clinic’s emergency policies. If you are living in a relatively urban area with an emergency facility, it is fair to assume your day vet may refer there after hours, and if you run into an emergency such as coyotes, cars, or sudden collapse, initial treatment and stabilization can easily cost four figures. Assume this. Assume the ER vet has to charge you upfront because people before you didn’t pay up later. So what is your plan if this happens?

Have a credit card with this much available balance on it

Have an untouched savings account with this socked away

Have ‘that one vet your sister mentioned who will totally do midnight emergency services for $0 down’ on speed dial.

Have friends and family willing to front you the money on sudden notice

Have pet insurance (though you still have to provide the money initially, you get reimbursed a percentage later, reducing the long term cost)

Know your financial limits and be willing to understand that economic euthanasia is an option

Go on a social media crusade after the pet dies, knowing you’re going to get hit just as hard as the target of your anger, harder than either of you deserve; solving nothing.

Your choice.