Scenario: Despite frequent appointments, a client's pets are often in poor to marginal condition, usually presented for conditions suggesting poor preventive care and lapses in husbandry.

Although the same pet is rarely seen more than once or twice, there is a regular stream of new animals, with the client showing great excitement over each new acquisition. She is vague about their source, as well as about the true number of pets at home. She always shows interest in news about other animals available for adoption but does not appear to follow through on care recommendations for pets brought in from previous visits. She may be willing to adopt a new animal, or several animals, at once, without any hesitation or consideration of the amount of time or expense these new additions would require. Your instincts tell you that something is amiss, but you are unsure about how to proceed.

Issue at Hand You are concerned about animal welfare, and suspect that the client is either a hoarder or proceeding down that path. Yet you don't feel justified, based on evidence you have, to formally report suspected abuse to authorities. Making an allegation, even in good faith, could alienate the client and further decrease the level of care for the animals, setting up even more barriers to successful intervention.

Options As with other types of suspected animal abuse, the veterinarian is faced with a few difficult choices: ignore the suspected problem and just go on to the next office call (this might be the easiest choice, but it ignores our ethical obligation to intervene), gather some more facts to better evaluate the situation, or report the suspected abuse to law enforcement immediately.

If some veterinary care is being provided and a dialogue with the suspected hoarder is possible, the situation is probably not urgent. Be aware that substantial mental health issues can be present in these situations, and they may require expertise beyond the skill sets of someone without a background in therapy and counseling. Consider contacting a social worker or therapist for suggestions on how to work with such a client.

An immediate report to law enforcement may be justified in some circumstances, such as cases in which animals are severely neglected or suffering. If a veterinarian is concerned but does not have the time or skills to engage in a more involved approach, it may also be best to file a report so an animal law enforcement professional can conduct a thorough investigation. Decision Making & Solutions Working with a hoarder, or even someone with hoarding tendencies, has been described as like working with a feral cat-it requires a slow, cautious, respectful approach and gradual building of trust. You must prove yourself to be completely honest, reliable, predictable, and dependable in each interaction, or setbacks are likely. If you decide to investigate further or begin a program to help the person improve care for his or her animals, consider the following approaches.

Building a Relationship The first goal is to establish whether animals in the home are truly at risk and, if so, to improve their care and prevent the acquisition of even more animals. Identify the staff member who appears to have the best relationship with the client-it may be you, a receptionist, an associate, or a technician. Gradually draw the client out in conversation to gauge whether he or she has any worries or concerns that may be a segue into constructive action.

The Human–Animal Bond: Client versus Patient Needs

Home Visits & Health Care Plans The best way to assess the situation is to encourage a home visit by a staff member. Consider offering a one-time special service to establish a comprehensive care plan. In conversations, try to redirect the client's attention to the needs of existing pets by demonstrating your concern and commitment to their welfare. Avoid suggestions of downsizing until trust is established, but do consider negotiating a moratorium on new acquisitions as part of the care package.

A one-time discounted rate for spaying and neutering existing pets could be part of such a deal. Or you could consider making appointments for new pets conditional upon appropriate follow-through for any previous visits. Through all of this, you must continue to demonstrate genuine concern for both the client and the pet, and suspend any tendencies toward judgment.

If the client continues to be evasive, consider driving by the home. You may get some additional confirmation of your suspicions by observing neglected animals in the yard, a yard or porch in disarray, or windows blocked or papered over.

Discussing Wellness with Clients

Involving Law Enforcement Should all these efforts fail to clarify the situation, consider approaching your local animal law enforcement agency. In some communities, this may be a humane society or SPCA with police powers; in others, it could be a municipal animal control officer or the local police department or sheriff. It may be useful to establish a relationship with your local animal law enforcement personnel well in advance of when you need them. Then, in a time of crisis, you will have a ready contact person to call upon. Asking your colleagues for names of people whom they contact in such cases may also help lead you to a good ally.

Veterinarians often feel the most unease about reporting suspected abuse because they are not positive that abuse has occurred. However, it is not the veterinarian's role to assess guilt or innocence. Rather, it is the veterinarian's ethical obligation to report suspected abuse so additional investigation can be done to determine whether actual abuse has occurred. Veterinarians are animal advocates, and this is our obligation to the animals we see in our practices.

The Investigation Process Veterinarian unease is understandable-you also have a right to feel comfortable with your choices. Disclose information at a pace that is comfortable for you and back away if you have concerns about the confidentiality of the report or concerns about how the investigation is being approached. Indeed, different agencies and different investigators may vary widely in their approach, experience, and skill level. The best way to assess that is by open, honest communication and through referral. It is also advisable to review the state practice act or consult with the state veterinary medical society about any statutes pertaining to client confidentiality and reporting suspected abuse.

The agency you approach may have a history with the client and know the situation well. That history may provide you with greater confidence in your decision to make a report. There is the possibility that more resources can better address the situation if all parties work cooperatively. As corny as it may sound, this can be an opportunity for a "good cop/bad cop" scenario, with the law enforcement agency insisting on certain care conditions and concessions and the veterinarian continuing the role as supporter and confidant to help the client meet these requirements.

Solution In an ideal world, your compassion for the clients and their pets will result in a situation where the human-animal bond is maintained, animal care and welfare improves, and the client relationship is strengthened. Even in the best of circumstances, ongoing attention and monitoring will probably be needed. This is where a trusting relationship with a staff member can help. Periodic calls to check in and see how everyone is doing may also help. In the worst case, should a more adversarial approach through law enforcement become necessary, you will still have fulfilled your oath to look out for the welfare of animals-and, whether the client realizes it or not, may have acted in his or her long-term best interest