Vet Expense

The High-Cost, High-Risk World of Modern Pet Care
 

Veterinarian John Robb steers his Chrysler out of the parking lot, gliding past the Dunkin’ Donuts and the boarded-up furniture store, and leaves behind another Saturday shift at Catzablanca, the clinic where he’s been reduced to working since losing his own hospital. There’s a big cardboard box stuffed with court papers in the back seat, the air conditioning is up against Connecticut’s July heat, and an audiobook of the Bible is playing loud. “When I get into the car,” Robb tells me, “I’m like, ‘Lord I need to hear from you.’ ”

It wasn’t a day harder than most, but he’d had to put a little girl’s cat to sleep while she sobbed in the reception area. Later, exam rooms got backed up while Robb investigated why another feline was vomiting. A cell phone picture of a flowerpot knocked over in the owner’s backyard suggested the cause: poisonous hydrangea blossoms. By the time Robb locked up for the night, the cat was resting in a cage, hooked up to an IV and meowing.

“I’ve probably listened to the Bible 500 times in the last eight years,” he says as we pull onto the highway, leaving the Hartford suburb of Rockville. “That’s when God decided to give me jobs at least an hour away from home.”

Eight years ago is also when he made what he thought of even then as a deal with the devil. Robb is a born-again Christian who believes he’s been called to protect pets, because, he says, they can’t speak for themselves. But concern for animals wasn’t foremost in his mind in 2008, when he decided to buy a franchise of Banfield Pet Hospital, America’s biggest chain of veterinary clinics. He was thinking about money.

Many veterinarians scoffed that Banfield dumbed down its medicine by using a software program, PetWare, to standardize care. The company also put its hospitals inside the big-box retail stores of PetSmart, turning medical care into a product to be purchased along with dog food and chew toys—just another item on a one-stop shopping list. A former chief medical officer at Banfield once compared the business to the no-frills carrier Southwest Airlines. “If you want first class,” he said, “you can buy it from a different airline.” Some animal doctors called Banfield “vet in a box,” but it was a gibe that betrayed anxiety. Veterinarians feared Banfield just as mom and pop grocery stores once feared Walmart.

Robb knew all of this. He also knew that a lot of doctors thought Banfield overvaccinated pets. But he had a wife and two kids to support, and he knew he could make a very good living with a pet hospital inside a shopping center.

A 57-year-old with thinning hair, Robb walks with a slight limp, the result of a high school football injury. He’s an excitable man, a freight train of a talker. Near midnight, he’s pacing in his New Fairfield farmhouse, still in the green surgical scrubs he wore to work, having talked nonstop from the minute we left Catzablanca. If his wife, Aldona, hadn’t touched him on the shoulder to remind him of the time, he might have ranted until morning about how Banfield stole his hospital and is turning animal medicine into an exploitative, even dangerous business. “It’s peticide,” Robb says, pausing before offering a definition. “The systematic destruction of pets by corporations for profit.”

Pet care is undergoing the same sort of consolidation that transformed human health care in the 1990s, and Robb has worked for both of the industry’s biggest players. In 1999 he sold his first practice for $1 million to VCA—then called Veterinary Centers of America—a consolidator that’s bought hundreds of animal hospitals and trades on the Nasdaq exchange under the ticker WOOF. He worked six years for VCA. Then, in 2008, he paid $400,000 for his Banfield franchise in prosperous Stamford. Banfield had itself traded hands just a few months before, when the veterinarian who founded the company sold it to Mars, the giant candy and pet-food manufacturer. The change had dire consequences for Robb and, he says, for millions of pets.

In December 2012, Banfield seized Robb’s franchise for violating its vaccine protocols and breaking Connecticut law. Robb doesn’t dispute that he started giving half-doses to little dogs after several almost died of vaccine reactions, but he says Banfield used that as an excuse to take his hospital—just as it came up with pretexts for taking hospitals from other veterinarians. Banfield sued Robb over his medical practices. Robb countersued, claiming breach of contract, and has turned his case, still playing out in court, into a crusade against Banfield, which he says pushes vets to put profit ahead of the health and safety of animals.

Banfield says its medicine is compassionate and sound. In a letter responding to this story and Robb’s accusations, the company writes: “We strive to understand the needs of pets and clients and provide safe, high-quality care to every pet, every time.” It’s Robb’s practices, Banfield says, that demand scrutiny.

The fight has gotten messy. Robb has picketed and been arrested. Once he was handcuffed to a stretcher in the aisles of PetSmart and carried to a psych ward; lawyers for Banfield and PetSmart accused him of “walking around the store in an erratic manner with Bible in hand.” Later, after failing to have the case thrown out, they tried another tactic: accusing Robb of witness tampering. The judge rejected that. Robb has made outrageous moves of his own. He turned down a 2013 settlement offer by asking for $20 million, triple what even he thinks he’s owed. If that wasn’t folly enough, Robb demanded that Banfield be renamed Protect the Pets and that he be made chief medical officer.

Now, as he waits for a trial, Robb seeks justice by social media. His “Boycott Banfield” page on Facebook draws a steady stream of bereaved pet owners and former Banfield doctors and nurses, few of whom seem to care or even know about Robb’s religious views or his commercial dispute. They’ve simply come to rage about Banfield and the corporatization of pet care.

By 1985, when Robb finished veterinary school at the University of California at Davis, animal medicine was changing. More technology came into play as hospitals started selling their old MRI machines and CAT scanners to veterinary clinics. And, as human birthrates fell, pets took the place of children in some families. In 2014 there were 179 million cats and dogs in the U.S., up from 98 million in 1980. Today, according to the American Animal Hospital Association (AAHA), more than 80 percent of pet owners think of themselves as their pets’ moms and dads. Americans love their pets so much, they spent $35 billion on veterinary care in 2015.

This outpouring of sentiment and money represents an amazing opportunity for businesses such as Banfield and VCA. Tom Fuller, VCA’s chief financial officer, has started investor presentations with a story about a man who drowns in a frozen lake trying to rescue his dog from a hole in the ice. “It’s horrible,” he says. It’s also one big reason, he continues, investors should love the pet-care industry. “We’re all kind of crazy about our pets. It’s why the business is so resilient.”

It’s not the only reason, though. In contrast to human medicine, in which everything from the nurse-patient ratio to the caloric count of injections is mandated and overseen by a web of government agencies, veterinary medicine is largely unregulated. And pet owners pay cash: Vets don’t deal with insurers haggling for better prices or questioning whether that vaccine or ultrasound or blood panel is really necessary. (A small percentage of pet owners carry insurance, but they pay vets upfront, like anyone else, and then take on their insurers for reimbursement.) What’s more, when veterinarians make fatal mistakes, they face no real financial consequences. The law hasn’t changed to reflect the attitudes of the average pet owner; courts still treat pets as property. Damages paid to owners whose pets have been killed or injured are so low that a typical medical malpractice insurance policy for a veterinarian costs less than $20 a month. Damages are so low, in fact, that few pet owners can find a lawyer willing to take even the most egregious case of veterinary malpractice.

When Bobby Hanners’s shar-pei, Charlie, died at a Banfield hospital in Hagerstown, Md., during a neutering in 2015, the company offered to do little more than pay for the dog’s disposal. “It was like, ‘Yeah, we lost his dog. We took care of his cremation, that’s enough,’ ” says Hanners, a manager at a Hagerstown McDonald’s and one of the pet owners who posted on Robb’s Facebook page.

Asked about the accident, Banfield responded, “There was no evidence of intent to harm or malice—this was a situation when a doctor was performing in a manner they believed was best for the pet.”

Hanners says Banfield’s veterinarian used the wrong sedatives and then tried to cover up the error. Even so, no lawyer would have taken the case if a Banfield employee hadn’t violated privacy laws by posting details of Hanners’s billing history on Facebook in an attempt to paint him as someone looking to exploit his pet’s death for money. “Quit looking for a check,” the employee wrote. Hanners sued for invasion of privacy and settled with Banfield.

West Los Angeles Animal Hospital may be the apotheosis of corporate veterinary care. When it became VCA’s first purchase, in 1986, it was already the biggest pet hospital west of the Mississippi River. Today it occupies a three-story building with an attached parking garage and is staffed by 60 doctors, including cardiologists, neurologists, oncologists, even a psychologist. There are underwater treadmills for overweight cats and gimpy dogs and a sterile isolation room for pets recovering from bone marrow transplants, a cancer treatment that can easily cost $16,000. “All the advancements that you hear about in veterinary medicine? None of that would be possible if it was just your neighbor working by himself like it used to be,” says VCA Chief Executive Officer Bob Antin.

Corporations now own 15 percent to 20 percent of America’s 26,000 pet hospitals, and consolidators, copying the model pioneered by VCA, are buying them fast. (Banfield is one of the few big businesses building its own clinics; the rest are rolling them up.) In 2014 a chain of 250 hospitals called National Veterinary Associates was purchased by Ares Management for $920 million. In 2015 the Ontario Teachers’ Pension Plan spent $440 million to buy a pet hospital group. Last May, VCA spent $344 million for a group of 56 hospitals pooled together by a smaller consolidator for the express purpose of flipping them. In the past 15 months, Mars has bought two hospital groups for undisclosed amounts, adding more than 100 clinics to a portfolio that already includes 950 Banfield locations. “The individual ownership of veterinary hospitals in America? It’s got one more generation,” says Bill Folger, a former board member of the American Association of Feline Practitioners. “Maybe two.”

This is all happening despite laws in most states banning corporations from owning veterinary practices. As old-fashioned as it may sound, the idea behind the laws was that doctors employed by corporations might have a harder time exercising independent judgment on behalf of patients; commercial interests could intrude. Nonetheless, there’s a reason states allow complicated ownership structures—called management service agreements—that get around these laws: It’s what the doctors want. When it’s time to retire, vets expect to be able to sell their practices at the highest possible price, and these days that typically means selling to a corporation. “Just remember,” Antin says, “in every state we’re in, even the person who runs the state association, they’re a practicing doctor, and they want the freedom to be able to get value for their practice.”

Antin says he and his brother Art didn’t know anything about veterinary medicine when they started VCA in 1986 with a friend, Neil Tauber. But they did know how to run a health-care business. They’d made a small fortune with an outpatient surgery chain in the early 1980s. In pet care, they saw an opportunity to apply modern management techniques to poorly run, undercapitalized hospitals that could benefit from economies of scale. Today, VCA employs 3,000 veterinarians and owns 750 hospitals. Robb Animal Care Center was somewhere around the 200th purchased by the chain.

VCA’s most important acquisitions, though, have been labs; the company combined about a dozen testing facilities to create Antech Diagnostics, the industry’s biggest laboratory. Antech does bloodwork and other tests for more than half the country’s animal hospitals and accounts for 41 percent of VCA’s operating profit, according to the company’s financial statements. Fuller puts it this way when he speaks to investors: “Diagnostics is what grows the industry.”

More testing can sometimes provide more certainty; it almost always makes medicine more expensive. The cost of veterinary care has risen even faster than the cost of human health care, more than doubling since 2000, according to the U.S. Bureau of Labor Statistics.

Independent vets have to balance the cost of covering every possibility against the risk of using more restraint. The corporations lean toward a maximalist approach. Diane Petrillo, a registered nurse from New Haven and a former client of Robb’s, tells a story about how this was taken to absurd lengths last May when her VCA vet wouldn’t renew a prescription for her cat’s lifesaving blood thinners unless she paid $450 to repeat an echocardiogram that 12 months earlier had shown a deadly heart defect. “You already told me he’s never going to come off the meds, so why not just give it to him?” Petrillo asks.

 

The answer to that question may lie in VCA’s annual financial reports, which say the company’s business strategy is “to leverage our existing customer base by increasing the number and intensity of the services received during each visit.” When I ask Bob Antin what he thinks about that language and Fuller’s statements to investors, he waves it off. Those communications, he says, are meant for a financial audience and don’t affect VCA’s veterinarians. “A veterinarian? The last thing they think of is, ‘I’ve done five of these today. Can I do six of them tomorrow?’ That is the single last thing a veterinarian thinks, and if that kind of person exists, I don’t see them.”

But those people do exist, precisely because of the pressure VCA puts on its doctors, according to Wendy Beers, a veterinarian who resigned in 2014 from a VCA hospital in Albany, Calif. “Every month they would print out things to say how many packages you sold, how many procedures you did,” she says. “And if they came out and said, ‘This month we want everyone to do 20 heartworm tests,’ and you only did eight, well, next month you have to do better. I don’t feel when they’re lecturing us that their chief interest is to make sure animals get the best care.”

An annual postcard reminding you that your dog or cat is due for its shots—“it’s time for the tough love”—is the main way veterinarians get pets in the door each year. That’s why many animal doctors, at every kind of practice, have chosen to ignore guidelines from the AAHA, which since 2003 has recommended dogs not be given what are called the core vaccines—for distemper, parvovirus, and adenovirus—more often than every three years. Indeed, the guidelines say a single series of these shots is probably enough to provide a lifetime of immunity.

“Some folks don’t like me to emphasize that,” says Ronald Schultz, a retired immunologist at the University of Wisconsin School of Veterinary Medicine and one of the guidelines’ main authors. He spent a career being rebuffed by veterinarians unwilling to accept the results of studies he’d been publishing since the 1970s on the long-term effectiveness of vaccines. Schultz’s former laboratory in Madison is one of the deadliest places on earth for any dog that hasn’t been immunized. Some dogs are locked in viral gas chambers. Others are injected with disease or have viral aerosols sprayed directly into their snouts. Decades of these tests have shown that a single series of shots is enough to protect dogs from the main canine diseases for seven or more years. “I could drown them in virus,” Schultz says, “and I couldn’t reinfect them.”

Still, asking veterinarians to forgo seven years of vaccine income would have caused a revolt, so Schultz and the others on the AAHA Canine Vaccination Task Force compromised at three years. “We split the difference,” Schultz says. “The idea was, let’s see if we can get them to walk before asking them to run.”

The standard for vaccine dosages has its own unscientific provenance. At some point in the 1960s, pharmaceutical companies simply settled on a round number that worked: 1 milliliter. Today, vaccines are the only pet medications that aren’t scaled to body weight. Whether it’s a 120-pound Great Dane or a 3-pound Chihuahua, one size fits all. Some doctors have wondered whether it would be safer to cut doses for smaller dogs or whether shots could be given less frequently, but those are expensive questions to answer, and when the numbers were first finding their way onto drug labels, hardening into dogma, pets weren’t that far from being considered livestock. They were just cats and dogs. It’s a telling anachronism that the U.S. Department of Agriculture is responsible for the safety of pet vaccines.

A pet may receive dozens of shots in a lifetime, at a cost of hundreds of dollars, but surprisingly little research has been done to find out how safe they are, and there is wide disagreement among experts. A 2005 study by Purdue University using Banfield data from more than 1 million medical records found 38 adverse reactions for every 10,000 shots, a rate of about 0.4 percent. Schultz and a research partner, Jean Dodds, argue the numbers are much higher, more like 3 percent or 4 percent, with about 1 in 200 dogs experiencing life-threatening reactions such as anaphylactic shock. “Vaccines can kill,” Schultz says. “If you don’t need to vaccinate annually and you do, you’re taking unnecessary risks.”

Whatever the real risk of an adverse reaction, it isn’t zero. The value of repeated shots, though, has pretty well been debunked. (Robb likes to point out that he himself has had exactly one rabies vaccine, in 1983, at veterinary school; he confirms his immunity through regular titer tests, something that can also be done for dogs and cats.) Nevertheless, more than a decade after the AAHA adopted its guidelines, Banfield still recommends on its website that dogs “be boostered yearly for most vaccines.”

Karen Faunt, Banfield’s vice president for medical quality advancement, says despite that language, the company’s vaccine protocols have been aligned with industry guidelines since 2010. “This is something that has evolved greatly in my time here,” she says. “I’m very pleased with that.” It’s true that Banfield has reduced the frequency with which it administers the core vaccines. Still, it routinely pushes annual boosters for others the guidelines say should be given “only in special circumstances.” Shots for leptospirosis and Bordetella, or kennel cough, are two examples of vaccines the AAHA says most dogs don’t need, but which Banfield regularly recommends.

Vaccines are at the center of Banfield’s main product, a selection of preventive-care packages called wellness plans. For a monthly fee of $30 to $60, a wellness plan covers exams, office visits, diagnostic tests, and shots for dogs and cats. Call any Banfield hospital, and you’ll be told it’s the vaccines that make the plans such a good value, because à la carte, they are as much as $40 each, along with $50 for each doctor visit.

Schultz says he contacted Banfield several times a year for many years to urge it to heed the full intent of the AAHA guidelines. “They’ve paid some lip service to it,” he says, “but they’re not listening.”

Banfield traces its origins to 1955, when a vet named Warren Wegert started a small animal hospital in Portland, Ore. On the company website, Wegert is shown in a photo as a balding, kind-looking man in a white doctor’s coat. But to call him Banfield’s founder wouldn’t be accurate. That distinction belongs to the younger man standing slightly behind Wegert in the picture: Scott Campbell, the veterinarian who purchased Wegert’s single hospital in 1987 and created an empire. Campbell forged the partnership with PetSmart in 1994 and created Banfield’s wellness plans. The son of a small-town physician who warned him not to go into human medicine because he thought “one day all the doctors would be working for the government,” Campbell is probably the world’s richest veterinarian. Since selling to Mars in 2007, he spends most of his time on his ranch, a spread in northeast Oregon that’s bigger than many national parks.

When Campbell started Banfield, the average veterinary clinic was an insular fiefdom run by a doctor who was on his own and accountable to no one. Maybe he was skilled and conscientious—and maybe not. To standardize care at his hospitals, Campbell computerized the records and developed rigorous treatment protocols, ideas he says he borrowed from his wife, Sandy, who worked in quality assurance at Kaiser Permanente, the giant network of human hospitals. “The whole profession got better because of what we did,” Campbell says.

To educate veterinarians in his methods, Campbell built a training program called Banfield Doctor Academy at company headquarters in Portland. Robb spent a few days there in the summer of 2008. He was surrounded by young doctors, he says, most of them fresh out of veterinary school. All the vets were taught to use PetWare, a proprietary software package with touchscreen menus that guide veterinarians through the process of diagnosing medical problems and prescribing care. Robb was sent home with a 116-page New Hire Doctor Workbook describing how to operate version 3.7 of the system.

That old PetWare manual makes for interesting reading. In one example, explaining how the software is used to prescribe treatment, the book shows a checklist of therapies for a dog with atopic dermatitis, or itchy skin. Doctors are encouraged to recommend a biopsy, analgesics, topical medications, antibiotics, a therapeutic dietary supplement, an allergy diet, and a flea control package. They’re required to recommend antihistamines, shampoos, serum allergy testing, lab work, a skin diagnostic package, and anti-inflammatories. It’s a treatment course that might run $900 for symptoms that, in a best-case scenario, indicate something as prosaic as fleas. In bold print, the manual reminds doctors: “You cannot change items that were initially marked Required. They must remain required.”

Faunt says since Mars took control, Banfield has distanced itself from Campbell. The academy is gone—the company’s vets now have to get outside the bubble for their continuing education. PetWare, too, has become less of a straitjacket. Faunt declined to show an updated version of the software, but she says the system is now an optional tool. “My understanding with Dr. Campbell was that he had a sincere belief that consistency was one of the hallmarks of quality,” she says. “We’ve transitioned to understanding how to provide individualized care for each pet. We learn every single year.”

One thing that hasn’t changed, though, is the wellness plan. Last year more than 2 million pets were covered by a Banfield wellness plan, and every dog on one still gets basically the same treatment, regardless of whether it’s a 10-year-old miniature poodle living in a high rise or a 2-year-old Labrador retriever that runs free on a farm.

The one-size-fits-all approach infuriated James Robinson, a vet who owned Banfield franchises in Tennessee until the end of 2014. “My two that I owned? I hated working at them, because it wasn’t real medicine. It just really wasn’t,” he says. “Like you got a 3-year-old dog, a completely normal dog with a good physical exam, and we’re going to run bloodwork on him. Umm, that’s kind of like doing bloodwork on your 8-year-old child.”

If the wellness plans make medicine into a standardized product, Banfield’s pet drop-off policy is what allows a hospital to hum at maximum efficiency. Pet owners are required to leave their dogs and cats all day when taking advantage of the plan’s twice-yearly comprehensive exam. For some people this is exactly why Banfield is so appealing—no more interrupting your work schedule for a vet appointment. For Banfield it’s a way to squeeze exams into the gaps between surgeries, walk-ins, and other appointments.

While pets wait for treatment, they’re warehoused in a wall of kennels at the back of the hospital—sometimes without water, because animals that drink need to urinate. Donna Smith, a licensed technician at a Banfield facility in Waterbury, Conn., who was fired in 2014, says staff at her hospital worked like a “pit crew,’’ with all the hurry and commotion that connotes. But instead of changing tires and refilling tanks, they were pulling dogs out of cages, giving vaccines, taking blood and fecal samples, and rushing through physical exams that might take no more than 90 seconds. “I once saw a doctor vaccinate the wrong dog because we had paperwork everywhere and so many dogs lined up,” Smith says.

Vince Giordano, one of the pet owners who contacted Robb through his Boycott Banfield page, says one-size-fits-all medicine is the reason his dog Max is dead. A worrying, protective owner, Giordano took Max to a Banfield hospital in March 2013 for some antibiotics after the dog sniffed a dead opossum during a walk in Giordano’s suburban neighborhood on Long Island, N.Y. Max was a 3-year-old Labrador mutt with a long list of unusual health problems, all of which were detailed in lengthy medical records from Banfield’s Suffolk County hospital, where the dog was a patient for most of his life.

About a year before the March visit to Banfield, Max had undergone chemotherapy to treat a malignant tumor found in his tail, half of which had to be amputated. Even before that, Max had exhibited allergies to vaccines, and Banfield had prescribed Benadryl to reduce his reactions.

When Giordano brought Max in after the opossum encounter, Banfield’s vet didn’t seem to consult the dog’s records or hear him explain the history. Instead, he says, she focused on her computer screen and began reading off a list of treatments that were due according to Max’s wellness plan. “She turned it into a vaccine session,” Giordano says. “She kind of twisted my arm and made me feel like an irresponsible dog owner.”

After Giordano resisted, the veterinarian suggested a compromise: just one shot, for leptospirosis. Giordano agreed. Thirty minutes later Max dropped dead at home. No Benadryl was administered, and the veterinarian didn’t take the precaution of keeping Max at the hospital for observation.

In a settlement letter offering $1,000 as a goodwill gesture in exchange for a promise not to discuss Max’s death publicly, Banfield said the decision to vaccinate “was made very carefully and deliberately.” Giordano rejected the money. Later he learned that leptospirosis is easily treated with antibiotics, and that, according to the AAHA, lepto vaccines “are much more likely to cause adverse reactions” than others. “There was no reason to give him that vaccine, especially after he got cancer,” Giordano says. “But we were on the program where they push the vaccines.”

Just a few months after Robb opened the doors of his new Banfield hospital in 2008, Mars began remaking the company. By the following January, an exodus of doctors was under way. A former McKinsey consultant who’d come up through the ranks at Office Depot was hired to run operations. Campbell was replaced as chairman by Pamela Mars-Wright. A granddaughter of Forrest Mars, the company’s founder, she’d run a dog-food factory for the family.

Mars is one of the world’s biggest family businesses, with annual revenue of more than $33 billion. Its corporate culture is infused with the personality of its founder, a perfectionist known for setting strict profit targets and berating employees who didn’t meet his standards. According to Joël Glenn Brenner’s 1999 book The Emperors of Chocolate, Forrest once ordered his youngest son, John, to get down on his knees and pray for the company for an hour in front of other executives.

Along with inheriting their father’s business in the 1970s, brothers Forrest Jr. and John also inherited his temperament and his ideas about profit. In the middle of the second floor of Mars’s corporate offices in McLean, Va., the brothers once placed a large butcher block adorned with a plaque that read: “head on the block responsibility.” The founder’s management philosophy, spelled out in a set of precepts called the Five Principles, still governs the family empire. When Robb bought his Banfield franchise, he was given a money clip embossed with the text of the fifth, crowning principle: freedom. “We need freedom to shape our future,” it said. “We need profit to remain free.”

The Banfield management shake-up soon filtered down to Robb. The veterinarian who’d sold him his franchise was fired. Pam Hale, the medical director to whom he reported, quit. “More people were making decisions that weren’t veterinarians,” she says. “That’s the reason I left.”

Leticia German, chief of staff at a Banfield hospital in Colorado from 2010 through April 2013, remembers the most disagreeable part of her job was making sure doctors hit sales targets. She answered to two field managers who’d come from Starbucks and treated medical care, she says, as if it were any other retail business. Under Campbell, Banfield had been obsessed with standardizing care; now there was an obsession with the numbers, especially the average patient charge, or APC. Doctors who fell short were made to attend workshops “to school them into how to better meet their numbers,” German says. “It was definitely intimidating.”

Pushing doctors hard was one way to make more money. Ending the franchise business was another. Under Mars, Banfield has winnowed the number of charters from 205 to fewer than 10 today, leaving behind a lot of angry veterinarians.

In December 2011, Robb received a registered letter from headquarters threatening to revoke his charter if he didn’t “cure” a long list of medical infractions, mostly having to do with record keeping. There was no mention of the thing that would eventually cost Robb his hospital: He’d been reducing vaccine doses for small dogs, a violation of Banfield protocol and, in the case of rabies vaccines, Connecticut law.

A few months later, Banfield made what Robb considered a lowball offer to buy his practice: $600,000. A veterinary hospital is worth, as a rule of thumb, about one year’s gross sales. Robb’s revenue in 2011 came to $1.6 million.

According to several other franchise owners and a former company executive who asked not to be named for fear of being sued, Banfield used similar tactics elsewhere: making below-market offers to vets who’d been softened up with the threat of having their charters revoked or not renewed. Robb’s wasn’t the only charter that got pulled. Robinson, the Tennessee veterinarian, says Banfield refused to renew both his charters and paid him nothing. Dale Lonsford, a Texas vet, says he lost his hospital the same way. When Banfield recruited the doctors, it hadn’t been a problem that they also operated their own independent clinics. Later, Banfield claimed they were in violation of noncompete clauses. In the case of Robinson’s Knoxville franchise, which Banfield seized in 2014, the offending clinic was 100 miles away. “They stole my hospital, and I think they’re sons of bitches,” Robinson says.Banfield says it made fair offers for both men’s practices, and CEO Vincent Bradley says the company treated all its charter owners more than fairly. “We’ve provided in my mind a fantastic exit for franchise owners that have decided to retire or exit or do something different,” he says. “Many of them, obviously, have taken advantage of it.”

After Robb refused Banfield’s offer, more threatening letters arrived. Field managers made unannounced inspections of the practice. Finally, in December 2012, he received a phone call from his regional director: His charter had been revoked, and he had 10 minutes to get out.

Litigants whose motivations aren’t strictly economic make for nettlesome adversaries. Ever since one of Robb’s former nurses set up the Boycott Banfield page for him in late 2012, people have been writing and calling to commiserate, ask for advice, and just plain vent. The numbers have never been huge—Robb once planned a picket of Mars headquarters, and only one person showed, a woman who flew from Canada—but the traffic has been sufficient to irritate Banfield. Last January, a doctor e-mailed Robb to tell him she’d quit a Banfield practice that morning. He posted her letter, and within hours, the doctor says, the company threatened to sue her if the letter didn’t come down. “They reprimand me for actually educating clients about over vaccinating,” the now-deleted letter said. “I was writing vaccine exemption letters which is allowed under state law and got reprimanded for that too. Isn’t it MY discretion to withhold vaccines if I feel it in the best interest of my patient? So angry!”

Robb has won, and lost, battles along the way. He scored some points in his legal case when the judge ordered Banfield to disclose how many deaths had occurred at its hospitals during dental work, which for a pet requires the same general anesthesia as any surgery. Banfield claimed that Robb hadn’t been monitoring anesthesia properly—that was another reason for seizing his practice—and this was a way to test that assertion.

When the data was divulged in 2015, it showed Robb hadn’t lost a dog during 2,241 dental procedures. (He says he’s never lost one during dental work in his 30 years as a vet.) Banfield, on the other hand, had lost 747 dogs in five years, about one death for every 2,000 dental procedures. Kim Van Syoc, Banfield’s head of public relations, says the loss rate at the company’s hospitals is no worse than it is anyplace else, but—as with so many other things in veterinary medicine—there appear to be no good statistics on the subject. Consider this, however: Many wellness plans include an annual cleaning, so some animals will go under anesthesia 10 or more times in a lifetime, for an entirely elective procedure.

Meanwhile, the giant drugmaker Boehringer Ingelheim did something that suggests Robb’s vaccine practices aren’t so crazy. In 2014 it began marketing the industry’s first half-millimeter doses, basically squeezing the viral load of a traditional shot into half the liquid volume by stripping out protein debris. It’s not the same thing as simply giving a half-dose, as Robb was doing in his own unscientific way, but the goal is the same: to reduce reactions. “It’s definitely beneficial for smaller animals,” says Mark Kimsey, the veterinarian who designed the product.

In that same year, the veterinarian appointed by the state health department to review Robb’s medical practices appeared to side with him. “I did not question Dr. Robb's passionate concern for his patients nor his integrity, nor that his protocol decreased the incidence of observed vaccine reactions,” Koen Loeven wrote in a letter to the health department's lead investigator.

Loeven went on to criticize Banfield directly. “I have been very distressed by the rise of corporate veterinary medicine and the pure profit motive being instilled in the medical process,” he wrote. “I have seen many clients from Banfield in my practice and fully agree with you in your disgust that they promote unnecessary vaccinations, over-vaccinate during a given office visit and generally push clients into excess expenditure at the cost of pet health and safety.”

Outside of the movies and the Bible, though, Davids rarely beat Goliaths. In November the Connecticut State Board of Veterinary Medicine recommended that Robb be put on probation and prohibited from ever giving a rabies shot again—a heavy blow to his economic prospects, no matter what he says about having broken a bad law in order to protect his patients. The state’s attorney general’s office is reviewing the board’s decision. In Robb’s case, a different judge is weighing a final appeal from Banfield to block the trial—and Robb’s standing could be much diminished.

If there is a trial, Banfield will have to contend with Robb in front of a jury and defend medical practices that have received little public scrutiny. And if the jury is representative of the country at large, more than half its members will have pets they think of as family.