Trauma and Trauma-Informed Care, ,

Please Send My Cat Home: What Our Health Dept. Doesn’t Want You to Know

Black cat on table, looking at camera.

Bear, on his 15th birthday, one month before his death.

I feel compelled to post this, even though it’s not part of the typical focus of my blog, because the New York State Department of Health (NYSDOH) is trying to keep you–anyone–from reading it. Silencing people’s voices is a behavior I actively challenge, so I feel a need to make a record, here, that can’t be silenced. To my loyal readers: I promise this won’t be a focus of many, many posts. And, as always, feel free to not read anything that doesn’t interest you.

I left a letter/appeal to the NYSDOH on their Facebook Page on Thursday, February 27th; by Friday the 28th they had evidently received enough separate posts, as well as comments on my entry, that the NYSDOH staff turned off their “Posts by Others” pane (the one that allows you to see what people other than NYSDOH staff have posted).

What doesn’t the NYSDOH want you to know about?

Warning–This could be triggering to animal lovers: A public health policy that allows them to seize the head of my 15 year feline companion, Bear, for rabies testing, after we had to euthanize him when he became critically ill after a long battle with chronic pancreatitis. They did this because he bit me, in pain, as I was trying to get him to the vet. This, despite the fact that:

  1. Bear was an indoor cat who was up to date on rabies vaccines;
  2. I had received bites several times in the past 6 weeks as a result of pilling him, and he lived, disease free, well beyond the 10 day observation period. It’s only because we didn’t want him to suffer, given he had suddenly started to experience extreme pain, that he couldn’t be observed for the required 10-days post-bite;
  3. Bear had receiving, closely supervised, ongoing care from my vet who knew he did not have rabies
  4. In 2013, none of the 35 rabies cases identified in Erie County were in a cat or a dog, they were all in wild animals.

We were informed that the NYSDOH will not return Bear’s remains to us, so we can have all of his cremated remains with our family, when they are done testing — even when the results of the testing are negative for rabies.

So I wrote them about the impact of this policy, both on me and as how it could affect other people in my situation: it’s hard enough to lose a loved pet, but imagining his head now separated from his body, being tested, and then thrown in with biological waste is very painful. And while I’ll be getting the ashes of his body back, it doesn’t feel like full closure since some of him is missing. And I requested policy changes that could prevent these negative impacts in the future and still protect the public health. And they received many comments. And then they hid the post (and comments) on their Facebook page — you can’t see it now without this link. Based on their behavior so far, I’m wondering if they will next just decide to delete the post, the comments, and the other posts that have been logged on their site about this issue. I hope not, but just in case I will post it here, too, so you can see exactly what I wrote, in case the link stops working. And for the time being, they are still accepting comments on their page (although you probably have to “Like” their Facebook page to do so), although it’s possible to turn that function off, too.

What did I ask for?

  1. My cat’s remains back (when he tests negative). I will pay for any costs associated with return — just send them back to my vet.
  2. Change the policy/procedure to make it less harmful to responsible pet owners:
    1. Give veterinarians some option to use their professional judgment — they want to fight rabies, too. My vet knew this cat didn’t have rabies. I’ve been accidentally bitten when pilling him several times in the past couple of months and the cat lived beyond the 10 day observation period I didn’t become sick. While the  current written policy indicates the vet and the health department should consult, my vet informs me that in our county (Erie), they always seize the animals remains even when the vet’s professional judgment is that there’s no rabies risk.
    2. Allow for some provision in the process to allow remains (when they are free of disease, of course) to be sent back to the vet, so the pet owner can have all of their pet’s remains with them. The owner can pay for the costs.

When Our Systems Hurt Us

I’ve written how the mental health system can inadvertently traumatize people while attempting to help. This whole situation is yet, another example, of systems that hurt, in this case, a public health system. I know that causing harm to pet owners and their families was not the intention of this policy. But it is, in fact, a result–I have lost many beloved pets over the years, but grieving Bear has been so much worse because of the images I have described and the knowledge I will never receive all his remains. I suspect there are many others who have been hurt — I’m just the person who is speaking up. In fact, one such person, C.R., commented on my post: “I am so sorry that you have to deal with this on top of your loss. I learned to never tell the vet about a cat bite due to a similar situation years ago.”

The way to keep systems from being hurtful is to use principles of trauma-informed care in creating and operating those systems. In this case, the concepts of collaboration and empowerment — actively seeking input and feedback from those affected by policies, as well as having mechanisms those people can use to have their voices heard are a good start.  Hiding the feedback on the Facebook Page (and never responding, I might add) is an example of yet more harm. It hard for me to trust the judgments of professionals who behave this way.

Post to the Health Department

My post on the Facebook page of the NY State Health Department 2/27/14

My post on the Facebook page of the NY State Health Department 2/27/14

1st set of comments

1st set of comments

2nd set of comments

2nd set of comments

3rd set of comments

3rd set of comments

4th set of comments

4th set of comments

View of the “Post by Others” Section on the NYSDOH Page on March 1, 2014

NYSDOH Posts by Others on Facebook

Post by Others Section of NYSDOH Page March 1, 2014. It disappeared Feb 28th. 
 You can post, but no one else can see it. Prior to that, anyone could see Posts by Others.

________________________________________________________

 3/9/14 Update

The NYS Department of Health Finally Responds

Five days after my original post on their Facebook Page, the staff of the NYSDOH responded there with this comment:

NYSDOH - New York State Health Department We are very sorry about the loss of your cat after a lengthy illness. It’s very unfortunate that you were bitten shortly before Bear’s death. Because rabies is transmitted through animal bites and is almost universally fatal, public health agencies are very concerned about the possibility of rabies transmission in every animal bite case. Bear was tested for rabies out of an abundance of caution and concern for your health. NYSDOH policies concerning rabies testing are consistent with national recommendations which have been endorsed by public health and veterinary organizations. In situations like this when an animal that has bitten a human or another animal has been euthanized, testing performed on the animal’s brain tissue is the only way to ensure that rabies transmission did not occur. Although rare, rabies does occur in vaccinated animals and in animals kept exclusively indoors. No vaccine, including rabies vaccine, provides 100% protection against the disease it is intended to prevent. A few years ago in New York, rabies was confirmed in an indoor-only cat; it’s possible that the cat had contacted bats within the home. In fact, during 2009-2013, an average of 28 cats tested positive for rabies in New York annually. We regret that the laboratory is unable to return any tissues that are submitted for testing, even when those samples are negative for rabies. Because an animal’s tissues are processed alongside those of other animals that might have rabies or other infectious diseases, the likelihood for cross-contamination is high. Thus, the return of any tissues from the laboratory could endanger the health of people or other animals.

NYS DOH Response to my Facebook Page Post

My Response to Their Response

My response was in 3 parts, each making a different point:

NYSDOH - New York State Health Department staff.Thanks for finally responding, albeit several days after I received a letter that informed me that "We recently sent an animal you or your pet came in contact with for testing. The New York State Rabies Laboratory test results on the animal were negative for rabies." Do you think you could modify your processes to at least acknowledge the cases where the potentially rabid animal you tested was someone's pet? Do you have any idea what it feels like for someone who is grieving to receive that kind of impersonal letter about a beloved pet? How much trouble would it take to put a check-box in your database to indicate this was a pet and then to send a different, more humane letter?

The end result of this policy, now that people are learning about it (and they will continue to learn about it), is that people will lie to their vets about cat bites under the conditions similar to what I went through. I've already heard from 2 people (out of about 100) who indicated that they have now done this. Finally, I am not convinced that your handling procedures couldn't be modified to eliminate cross-specimen exposure if your offices knew, from the beginning, that an animal was a beloved pet. Citing national guidelines is meaningless when they are created in the same, non-collaborative context that has been evidenced in my experience throughout this process. When you don't involve your concerned public in the shaping of policies that affect them (in this case, pet owners who might confront the reality that I confronted), you will get people finding ways to bypass the rules. In the long run, this will go much further to risk the public health than the rare indoor cat instance that you cite (although it wasn't clear if that cat was vaccinated). I, for one, would be willing to sit down with whomever designs these processes/procedures to see if we might come up with a win-win solution: one that meets your public health goals, doesn't increase the risk of complicated grief and related mental health disorders in your public, and doesn't create incentives for people to "game" the system. If you would like to contact me to take me up on such an option, simply send me a Facebook message, contact me on Twitter (@njsmyth), or contact me at my job at the University at Buffalo School of Social Work. 






My Response to NYSDOH’s Response

And my final response, upon reflecting longer about the statistics they presented:

NYSDOH - New York State Health Department Staff: I have some questions about your rabies data. You quote an average of 28 cats per year in NY State testing positive for rabies, but you didn't tell us the average number of cats per year who are tested. For example, last year, 9/1035 cats tested positive for rabies in NY -- that's a pretty low incidence rate. And what percentage of those cats who tested positive were indoor and vaccinated pets? My guess is that most were ferals/strays. Do you even track the data this way? One would think that this would be an important distinction in formulating thoughtful public health intervention. Based on how my case was "processed" I would guess that you don't track the data about whether the animal tested was a pet, because it was pretty clear that assumption was built into the entire process that the animal being test was NOT my pet. However, if you do track the data this way (distinguishing pet cats from ferals/strays and whether or not pet cat was vaccinated), I would appreciate seeing it.

My Last Comment to NYSDOH

Each of these comments was tagged so the NYSDOH staff would be alerted that a comment was directed at them. As of today, 3/9/14, they have not responded further.

NYSDOH Decides to Reverse Their “Hide Negative Feedback” Stance

Related to the issue of covering up the protests, the NYSDOH staff decided to reopen the view-ability of their “Posts by Others.” I made a separate post congratulating them on this decision and noting that hiding posts is not considered the best practice in responding to negative feedback in social media.

Support From the Buffalo Blogosphere

In the interests of providing a complete record of this experience, I would be remiss if I didn’t mention some support I received from a fellow Buffalonian. In addition to the 80+ comments on my post, the additional separate 15 posts of protest logged on NYSDOH Facebook Page, and many tweets, including some that that tagged the NYSDOH (@HealthyNYGov), a Buffalo blogger, Peter Reese, pick up my story and offered support through his influential Artvoice blog: When Government Attacks Us

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