That question has vexed Nancy and Tom Stanley, both nurses, since their cheeky chocolate Lab, Baxter, died in February at the VCA Old Marple Animal Hospital.
"When something unexpected or catastrophic happens in our work, physicians talk to the family," Nancy explains. "Without that, the family is left with an open wound."
But even if a vet doesn't do postmortems, wouldn't common decency suggest alerting billing and marketing to a patient's passing?
Instead, the Stanleys are being hounded for money they can't possibly owe. And they've received crass come-ons in the mail with lounging Labs surrounded by paw prints:
Time flies when you're having fun. Baxter, it's time to schedule your next visit.
Can you imagine such insensitivity from a pediatrician?
Gone in a flash
The Stanleys got Baxter as a puppy in 2002. A lovable "maniac" he remained until February, when Nancy rushed the trembling, vomiting dog from her Springfield, Delaware County, home to the nearest 24-hour animal hospital.
Nancy, who spent 20 years as an ICU/ER nurse, says the vet suspected Baxter had swallowed a toy or sock. But an abdominal X-ray was clear, so he got fluids and went home after the Stanleys paid $645.36.
The couple took the dog back the next morning, and a chest X-ray revealed pneumonia. Baxter, a different vet assured, would be fine after a two-day, $1,507.26 dose of oxygen and antibiotics. As required by the hospital, the Stanleys paid half the bill up front.
"When we left at 3 p.m.," Nancy recalls, "he was on oxygen in a plexiglass cage." At 5:30 p.m., the Stanleys were summoned back with news that Baxter "had taken a turn for the worse." They found him bleeding from the mouth and agreed to have him put down and cremated.
"It was obvious he was dying," Nancy recalls somberly at the family's dining-room table. "His eyes were open, but glazed."
The sound of silence
Two days later, the Stanleys got a call from Marple medical director Robert Lawrie, saying he'd investigate how and why Baxter had died.
Days passed, then weeks. In March, according to Nancy's records, she reminded Lawrie that she had prepaid for care and medications Baxter couldn't possibly have received.
"We'd like a refund." They also wanted Lawrie to void a mysterious new $400 bill - for cremation? - that arrived after the dog had died.
Weeks passed, then months.
By June, the bonus bill was 90 days past due, and the Stanleys received a "demand letter" for $451.82.
Also in the mail? Another promo from the animal hospital.
"We enjoyed meeting Baxter and you, too!" read the solicitation, which came with a $10 gift certificate urging a return visit.
Nancy seethed at the sight of the letter. "I don't see how anyone who says they love animals can treat a family who's lost one like this."
I left three messages for Lawrie, but got no response until 9 p.m. Friday. The vet said Baxter "got the best care possible" at the hospital, adding that animals suffering from pneumonia sometimes decline dramatically. He couldn't shed light on why his billing department seeks more money from the Stanleys, but did allow that the posthumous marketing pitches in Baxter's name represented "a terrible administrative error" caused by his keeping the pet's file active to review.
Pennsylvania's Board of Veterinary Medicine has no discipline cases against any of the people involved in Baxter's care, but the spokesman says the Stanleys could complain there and with the Attorney General's Office.
Tom, a retired nurse anesthetist, doesn't want paperwork. He seeks answers to heal that "open wound."
"I feel bad," he admits, "that we didn't think to have an autopsy."
To them, Baxter was family. But in the end, he was still a dog.
Contact Monica Yant Kinney at 215-854-4670, email@example.com, or @myantkinney on Twitter. Read her blog at philly.com/blinq