Thoughts on the use of sodium pentobarbital for lethal injection

Your excellent JAVMA news article on lethal injection¹ in the December 15, 2007, issue was right on target and may do a great deal of good in the human field.

As a practicing veterinarian for more than 50 years, it has always been difficult for me to understand the continual problems related to lethal injection of convicted murderers in our various prisons. Many veterinarians of my acquaintance feel the same. Why is such a simple procedure made so complicated?

My choice for euthanasia has always been a simple overdose of sodium pentobarbital, which, in recent years, I have frequently administered in combination with phenytoin sodium for cardiac effect. The injection is given intravenously and sometimes preceded by a tranquilizer, depending on the patient's temperament and condition.

It is such a problem-free drug that sodium pentobarbital can even be used in the presence of the owner, once they have been carefully told what to expect. More times than I can remember, I have been thanked by a grateful owner for making their pet's exit so painless and peaceful.

I am old enough to remember doing many types of surgery in animals anesthetized with sodium pentobarbital administered at a carefully controlled dosage. Used properly, it has virtually no side effects and is quite versatile.

So perhaps it is long past time for our friends in the human field to learn from the veterinary profession. In well-trained hands, when properly administered intravenously, sodium pentobarbital should be an effective, painless, and swift method for lethal injection.

Bud Stuart, DVM

Santa Barbara, Calif

Comments on effects of pet insurance on the veterinary profession

I am writing in response to the recent coverage of the November 2007 Executive Board Meeting in JAVMA.¹ In reading the Board's comments on pet insurance, I believe we have overlooked two bigger questions. First, are we looking to the pet insurance industry for hope that owners will magically consent to diagnostics and treatments they would normally decline? And second, as a result of such intervention, will the outcome of care change? Indeed, the AVMA's own Executive Board boldly states that it believes a “GHLIT-endorsed pet insurance program would promote quality veterinary medicine and reduce euthanasia [italics added].”

Proponents of animal health insurance often argue that you will no longer have to euthanize animals for financial reasons, playing to the heart strings in all of us who have chosen a career in animal health. Suddenly, financial obligations and decisions will melt away in the presence of an insurance policy, and you will be left unencumbered to make diagnoses and treat your patients. And while this may be true in some instances, most cases will still involve the same difficult choices and discussions they always have. If not, then veterinary medicine will have achieved true mimicry of the human health-care model. Rather than listening to patients (and owners) for guidance in their care, veterinarians will make diagnoses and prescribe treatments because insurance allows it, not because they should. As a result, pet care will begin to cost more, causing insurance companies to pass these added expenses to the owners. These same companies will delay or deny payments, form medical review boards to oversee care, and set reimbursement fee schedules to improve their medical loss ratios.

The proverbial foot is in the door. Owners are currently gobbling up health-care policies for their animal's eventual sick-care needs. Currently, pet insurance clients are reimbursed under the classic fee-for-service arrangement. However, this too will change. Veterinarians will be asked to join the network to retain access to the network's clients but, in doing so, will have to accept the plan's negotiated rates. Later on, veterinarians will be asked to accept assignment of payment from the insurance company rather than from the owner. Medical necessity will have to be justified to ensure payment, and denials (which help maximize insurance company profit) will have to be contested. Accounts receivable will soar in the face of everdwindling reimbursements. The cost alone to the profession of the additional manpower, software and equipment, legal fees, and bureaucracy for insurance billing will be staggering.

But the real question remains, will the quality and outcomes of veterinary medicine improve with pet insurance? This has certainly not been the case in human insurance-based medicine. I fear that the same insurance-dependent shortcoming of practicing human medicine will soon besiege the veterinary profession. I also believe this topic requires more discussion among the profession before the AVMA sets policies (see JAVMA News, March 1, 2007) and negotiates partnerships with pet insurance companies.

Casey Brechtel, DVM, PhD

Galveston, Tex

Applauds changes to JAVMA and addition to staff

Drs. Matushek and Audin are to be commended on the January 1 JAVMA editorial.¹ It is appropriate to place more emphasis on evidence-based medicine and the use of the new headings being implemented. We have long been a laggard to our colleagues in animal, dairy, and poultry science in the publication of scientific data.

Dr. Audin is to be congratulated on the employment of Dr. Sandra Lefebvre as assistant editor. Dr. Lefebvre's commitment to evidencebased research will aid in the quality of papers published in our journals.

George C. Scott, DVM

West Chester, Pa