COVID hits your practice… Now what?

Consider it carefully: Just because it’s lawful to stay open doesn’t mean we should

This summer, on the very day I had surgery that laid me up for two whole weeks, I emerged from anesthesia to learn one of my technicians tested positive for COVID. That’s about all I (barely) remember from that day. My immediate response was, “Close the clinic. Take everyone to get tested today. Hire a disinfecting crew.”

I felt clearheaded about my decision, instinctual and anesthesia-muddled though it may have been. I couldn’t imagine any other way to handle the situation. My staff is my second family. If my sister or brother worked here, I’d want them home, too.

It was one person positive out of 20 employees, not a good ratio in the midst of a drastic spike in our community’s caseload. (BTW, the clinic is in Miami). I can’t force my staff to work when we know with certainty the virus has been in the building. Right?

The mechanics of a closing

The next day, still drug-addled, I sent an email and social media message to all our clients informing them we’d had to close. I explained why. Meanwhile, we made do on the shoestring emergency contingency plan we’ve adopted for hurricanes and other calamities.

The telephone remains our lifeline. Much though we’re trying to train our clients, they still prefer to call and get through to a human. So we’ve hired a triage service as telephonic backup. They fielded all the calls and contacted us whenever a client truly needed help they couldn’t offer. We kept up with our social media accounts and did our best to stay connected.

Client reactions to a shutdown

The response was overwhelmingly positive and supportive. But did a few clients slip between the cracks? Absolutely.

It wasn’t seamless or perfect in any way. But it could have been worse. Some clients kept calling on back lines they’d erroneously saved. One such caller Yelped her displeasure. By some miracle, I caught that one immediately and she changed her post right away.

I’m sure we lost others who weren’t so patient, understanding, or forgiving. We also missed all the potential new clients, along with any existing ones with emergent cases that couldn’t wait. While most engaged pet owners will surely come back, a percentage won’t—at least not for a visit or two. That’s the reality of working in a competitive environment.

Did it hurt?

Did we take a financial hit? Oh yeah… it cost us more than just new clients, acute cases, and lost visits. The emergency disinfecting service was by no means inexpensive, but what really hurt was payroll. A backlog in testing due to the COVID spike in our area meant most of our staff had to wait over a week to get test results. We paid them, which is only fair. That’s what the Paycheck Protection Program (PPP) is for, after all. (Like most practices in the U.S., we’d received funding for 10 weeks of payroll.)

Not everyone agrees the solution is so obvious. I learned today more than one practice in our area has elected to remain open under similar circumstances. I’ll confess to being appalled and feeling rather judgy at first. How could they put lives at risk? It’s like stubbornly refusing to wear a mask despite knowing for sure it helps others stay safe. (Mask haters, please refrain from sending hate mail I will not read.)

Yet, I quickly softened my stance. Every practice is unique (well, mostly). It’s quite possible these places had mitigating circumstances conspiring to absolve them of what I perceived as their ethical duty to close. Perhaps the individuals worked in a secluded area of the hospital and had minimal contact with others. What if the practice housed the area’s only ER?

So did I really need to close? I entertained the thought, and, truth be told, have been obsessing over it ever since. So I looked it up on the Centers for Disease Control and Prevention’s (CDC’s) website, where I read this:

“CDC advises that critical infrastructure workers may be permitted to continue work following potential exposure to COVID-19, provided they remain asymptomatic and additional precautions are implemented to protect them and the community.”

In case you’re wondering, those “additional” precautions include standard temperature checks, mandatory face masks, social distancing of six feet (“as work duties permit in the workplace”), and careful disinfection.

The by-the-book solution

So the regulatory answer is a fairly solid “no.” I did not have to close. As long as we’re deemed “critical infrastructure,” there’s no legal mandate to shut down when an employee tests positive. An owner is well within their legal rights to remain open, even if staff members work in close proximity and while offering elective services, regardless of how many employees test positive or their degree of public interaction.

Again, I was kind of shocked. Our employees are everything. Sure, we know now that everyone else tested negative, but it could have been devastating. Our technician might’ve been a super-spreader, enabling our young staff to carry it home to infect their families. Our one elderly veterinarian could have died.

Apart from the ethical and acute financial considerations, there are legal ramifications, too: What if one of our clients or employees files a negligence or wrongful death suit? What does Workers Comp say?

More to the point, what would our employees and our clients want us to do? It’s pretty obvious they’d prefer we take the safest route and close down temporarily. Being transparent with everyone and allowing individuals to take their own risks is second-best.

Doing business as usual would inevitably court dissent and foment resentment, don’t you think? Ditch the transparency (some practices apparently elected this approach) and now you’re wading into legal murk, ethical sludge, and a swamp stocked with the potential for both team and client revolt.

But, of course, “safest” is also the least financially appealing for any owner. We have a profound stake in staying open. Some might not be in a position to close without shuttering forever. (We’ve seen more than our share of that among the smaller practices in my area).

But still… these are lives we’re talking about.

Do you know what you would do?

I’m not telling you all this so you’ll think me especially ethical and upright. In fact, if I’d had all neurons firing I might’ve taken a calculated risk and made do with a skeleton crew. But I know I made the best decision I could at the time with the information I had and I’m OK with that.

Still, I’m raising it here because this scenario is so new that few of us have thoroughly thought through what we’d do under similar circumstances. There are no professional standards or legal precedents to help guide us.

We’d all like to think we’re doing the best we can, but are we? Consider it carefully: Just because it’s lawful to stay open doesn’t mean we should. And be prepared. Don’t let it catch you while you’re laid up in a hospital bed under the influence of drugs. This much I know for sure.

Patty Khuly, VMD, MBA, owns a small animal practice in Miami and is a passionate blogger at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.

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