What Happened to "Patch Parker" as a Result of South Carolina Vet Frank Hooper's Substandard "Care?"

The South Carolina Veterinary Board has demonstrated that, although it has a mission to "protect citizens by ensuring that only qualified and competent veterinary practitioners operate in South Carolina," like other vet boards, it doesn't seem particularly eager to publicize the details that gave rise to its disciplinary actions.

As a rule, South Carolina's "Consent Agreements" are lacking in adequate detail for a consumer to really figure out what happened. Why is this a problem?

This is a problem because, as a consumer, it is vitally important for us to know what the veterinarian did, so that we can evaluate and assess his or her behavior. This kind of information is critical for making informed choices about veterinary care.

So, it is a good thing that recently, the South Carolina Vet Board began making the "Formal Complaints" available on its website. The Formal Complaint is the document filed by the Veterinary Board charging the vet with violations, and it typically includes more detail than the final "Consent Agreement."

Nonetheless, the IMPACT on the patient of the vet's behavior is often omitted from both documents. Perhaps this is because vet boards do not want to state that the vets behavior actually caused the death or injury of the animal. And maybe they don't want to say so because they can't be sure that's true. On the other hand, maybe they don't want to say so because it would indicate to the consumer exactly how dangerous this vet may be. Goodness knows, we wouldn't want to give the consumer information that would steer him away from a vet, would we? Even if that vet had behaved dangerously. Oh, but there is that little problem of the mission statement . . .

Both the Consent Agreement and the Formal Complaint filed by the Board in the case of Frank Hooper and his treatment of Patch Parker are lacking one important fact, and leave the reader asking: "WHAT HAPPENED TO 'PATCH'?"

Well, I think we can make an educated guess. Here are the facts that we do know . . .

In the Formal Complaint, the Veterinary Board asserted that in January 2007 " . . . an American Pit Bull named 'Patch' was presented to Guingnard Veterinary Clinic incident to a severe limp. Patch could not place weight o his front right legl. Patch was examined by another veterinarian. The owner reports that the other veterinarian opined that the leg was fractured and required surgery. The owner provided consent to repair the fracture."

Two days later, vet Frank Hooper operated on Patch. The Board says that Hooper's "records do not document the completion of a physical examination of Patch before commencing surgery. [Hooper] did not notify Patch's owner that Patch's surgery would be more extensive than originally assumed by the other veterinarian."

[OK, what's that supposed to mean? Please tell me -- if you DO NOT conduct a physical exam of a patient prior to cutting into him, how the heck do you know you need to, uh, expand the surgery and make it more extensive?]

Hooper, the document says, did not contact the owners before surgery.

Then, the document says, "The surgical procedure was extended due to the unavailability of certain equipment, a personnel shortage, and the complexity of the procedure."

[Um, what? Did he not CHECK to make sure he had all the needed equipment and staff before starting????? So, basically, this dog was under anesthesia longer . . . ?????

Hooper, it says, ". . . interrupted the surgical process while the animal remained under anesthesia. [Hooper] permitted his technician to depart from the area without ensuring that someone monitored the animal. [Hooper] failed to ensure that the oxygen supplies for Patch's surgery were adequate and to ensure the availability of equipment that was necessary for Patch's surgery."

"A review of [Hooper's] records relating to this mattre reveal that a physical examination was not conducted prior to the procedure. [Hooper] failed to rcord the route of administation of Telazol, a controlled substance. [Hooper] did not record the dose and administration of Atropine."

The document goes on to cite the violations the Board charged Hooper with, which include failure to "provide or maintain proper facilities, engag[ing] in unprofessional or unethical conduct, and engag[ing] in incompetent or negligent conduct" as well as failure to provide proper supervision of the technician and failure to keep proper records for Patch's treatment and drug administration.

What the document does NOT say is what happened to Patch.

What do you think?

Is it your guess -- as it is mine -- that the dog probably DIED? After all, we have:

• Failure to examine the dog prior to surgery


• Expanding the surgery to make it more "extensive" without ever having examined the dog


• Prolonged surgery in which the patient was apparently left under anesthesia while people left the area


• Reference to inadequate oxygen supplies and inadequate equipment, as well as failure to record how much anesthetic drugs they gave Patch and how they were administered

Do you think -- without saying what happened to Patch -- consumer's will realize that this kind of behavior COULD LEAD to the death of a patient, whether or not it did?

LINKS:

Board Consent Agreement with Frank A. Hooper

A History of Prior Violations and New Allegations of Animal Cruelty, but The CA Vet Board Still Wants Them to Get Their Filthy Paws on your Pets!!!!

The Order Signed by the California Veterinary Board in August, 2008 wasn't the first violation committed by Oasis Veterinary Clinic and Hospital and Ronald Walker, DVM, its managing vet. In 2006 the CA Vet Board ordered Walker and his clinic to "take such measures as [were] necessary to practice at an acceptable level of care." Yet, the dizzying and frightening list of violations alleged by the CA Vet Board -- seven in all, including an animal cruelty -- beg the question: WHY DOES THE CALIFORNIA VET BOARD ALLOW OASIS AND WALKER TO CONTINUE PRACTISING

AT ALL?

The facts are these:

Approximately 3 years after fining and disciplining Walker, the Veterinary Board issued an accusation against Walker and his clinic based on an inspection conducted by a board investigator. The Vet Board charged Walker and his clinic with:

• Unsanitary Conditions


• Failure to Maintain Aseptic Surgical Suite


• Animal Cruelty


• Failure to Comply with Emergency Services Requirements and Inoperable Phone


• Maintenance of Misbranded or Expired Drugs


• Violation of Health & Safety Code Section 2514.13 (this deals with failure to properly dispose of x-ray developer fluid, which the inspector said was being improperly disposed of into the public sewer. Public health endangerment, perhaps?


• Failure to Provide Medical Records on Demand

The outcome of this case is that the Board entered into (yet another) "stipulated settlement" with Walker and Oasis. In this settlement, Walker and his clinic admitted to all of the charges except for animal cruelty - and guess what? As part of the "settlement" with the vet, the Vet Board simply dropped (dismissed) it's animal cruelty charges. Please read what the investigator report says, you be the judge! (It is right for the vet board to dismiss charges of animal cruelty in spite of what the investigator saw with his own eyes!???)

For the remaning 6 violations, the vet board placed them on 3 years probation. They ordered Walker and the hospital to reimburse them for their "enforcement" costs, in the amount of $3,575. Please note that this was reimbursement to the board for it's costs, NOT a punitive fine for their dizzying and horrifying violations. Outrageous! No punitive fines! The Board ordered them to take 8 hours a year of continuing education -- that's just one working day!

Oh, the Board "revoked" their license but STAYED THE REVOCATION (which means, pretty much, decided not to enforce it), opting instead for mere probation which means of course, they keep funneling pets in the door.

Now, you tell me: Given the history of prior violations, and the truly frightening findings of the Board investigator (details below), do YOU think the Board's discipline is sufficient, either as a punitive measure or to incentivize Walker and Oasis to clean up their act? More importantly, is it sufficient to "protect consumers and animals" -- which they SAY is their mission?????

Here are the accusations based on the investigation, in detail. You will recall, as I stated above, that Walker and Oasis admitted them all except for the animal cruelty charge -- so the vet board simply retracted that charge in the final settlement. I guess BOTH Walker AND the Board know what kind of incendiary effect an admission of animal cruelty might have on public perception of a vet -- but unless the investigator is outright lying (do you think he is, with everything else Walker admitted to?) then he SAW what he SAW, so YOU be the judge as to whether it is "cruelty" or not -- I certainly think it is!

As you will read, among the allegations ADMITTED to, include caged animals sitting in their own waste with no food or water, keeping used syringes to be cleaned for RE-USE (!), un-sterile conditions including dirty surgical instruments, and more!

UNSANITARY CONDITIONS
(The truth of this charge was admitted by respondents Ronald Walker and Oasis Veterinary Clinic in the settlement)

"On or about January 25, 2008, during the course of an unannounced inspection, the Board's inspector identified many violations of the Board's standards of cleanliness and sanitary conditions, including, but not limited to, the following:

• a. The reception area was dimly lit, and smelled of urine


• b. Bulk liquids were stored in a cupboard with a mixture of spilled medication completely covering the cupboard's bottom, cementing an old cardboard box and stuffed animal toy along with the bottles to the bottom of the cupboard.


• c. The treatment area was dirty and had a pit bull patient with wounds on its rear legs running around freely. This dog had no access to food or water.


• d. The treatment room's counter was dirty and had 15-20 used syringes with needles stabbed into a pad, many used needles in the sink, a plastic jar full of used needles, and several used needles lying around the sink. There were also used syringes with condensation inside apparently to be used on patients again. The floor was dirty with blood and scrub, or surgical soap. Many old endotracheal tubes, some without viable cuffs, were piled in a bowl on a dirty cart.


• e.The surgery room's sink was dirty and appeared to be partially disconnected from the water supply, but still connected to the drain. The surgery table was littered with used surgery instruments, including several hemostats still clamped to a uterus. The mayo stand (a small stand used in surgery) was covered in blood and dirty instruments. A surgery pack was opened and used for a procedure, but there was no indication of a sterile indicator in the pack remnants. The flooring was cracked and pulling away from the wall in places. The wall was damaged and has chunks missing in one corner.


• f. The ambu-bag, a squeezable bag used to assist a patient to breathe, was left out on the O2 tank rack and was crushed and covered in an unidentifiable sticky black material. The stored packs, packs of surgical instruments used for a procedure, were wrapped in porous towels and had no sterile indicator tape on them. The orthopedic kit was not sterilized. The door from treatment into surgery has a hole in it were the window used to be.


• g. The back kennel area was extremely dirty and smelled so strongly of animal waste it was difficult to breathe. Every animal there was sitting in a mixture of feces and urine. None of the dogs had food or water. Only a cage with two kittens had food and their water was dirty.


• h. The bathing area had water flooding on the floor. There was also a bucket of used needles and syringes which were apparently waiting to be cleaned for re-use."

FAILURE TO MAINTAIN ASEPTIC SURGICAL SUITE
(The truth of this charge was admitted by respondents Ronald Walker and Oasis Veterinary Clinic in the settlement)

During the inspection referenced above, the inspector found that:

"The surgery room was not clean and sterile. The floor and walls have damage that makes it impossible to adequately sanitize certain areas as required . . . The instruments that were present were dirty, including the presence of animal tissue in violation of [citation]. The surgical packs present were wrapped in a porous material that would allow contamination to strike through the material and contaminate the instruments inside. There were no devices to measure and confirm sterility of the packs pursuant to the requirement of [citation]. A sick patient was being housed in the aseptic surgery room. This patient might have contaminated the room, exposing the next patient to risk of illness. The sink in the surgery room with the connected drain is a source of infection for patients. The condition of the surgery room was so inadequate that no surgeries could be properly performed there, and, in any case, [Walker] did not have the necessary equipment to perform sterile surgery."

ANIMAL CRUELTY
(Walker and Oasis Veterinary Clinic denied these charges, and the vet board withdrew them. However, in the "accusation", the inspector for the board reported seeing the following . . . )

• a. There were two dogs (patients) running free, one in the treatment room and one in surgery. Neither dog had access to food or water. The dog in the surgery room appeared to be very ill, barely responding when the inspector entered the room. The dog also appeared to have an injury on its left rear leg. All of the client-owned animals in the treatment room cages had feces and uring in their cages. Two cats had no litter boxes, food or water in their cages. One of the cats appeared very ill and the Board's inspector was told that [Ronald Walker and Oasis Veterinary Clinic] were not treating him because the owners were probably going to euthanize him. Otherwise, the Respondents' employee did not know who the patients were, and was unable to indentify them by name or owner.


• b. The kennel area was extremely dirty and smelled so strongly of animal waste it was difficult for the inspector to breathe. The runs did not have passive drainage, and all the animals were sitting in feces and urine pooled on the floor of the compartments. None of the dogs had food or water. All bowls were empty. Two kittens had food in their cage, and only dirty water."
  

EDITORIAL COMMENT: I find it outrageous, and a perversion of justice, that the veterinary board withdrew the animal cruelty charge -- which was based on its own inspectors report -- particularly when many of the same allegations in the animal cruelty charge were repeated in charges that the vet, Ronald Walker, ADMITTED TO. He admitted to the truth of the other six counts. Those six counts include a reiteration of the observation that animals were kept in their own feces, most without access to food and water. Is this, or is it not, cruelty? Don't ask the vet board -- apparently, just a little resistance from the vet, and they change their mind and decide that it's not. DO YOU THINK IT'S CRUEL?

FAILURE TO COMPLY WITH EMERGENCY SERVICES REQUIREMENTS AND INOPERABLE PHONE
(The truth of this charge was admitted by respondents Ronald Walker and Oasis Veterinary Clinic in the settlement)

During the inspection described above, the inspector found that Oasis Veterinary Clinic "did not have notices posted outside their building of where emergency services could be obtained when their clinic was closed as required . . . The phone number listed for emergencies was the clinic's own telephone number . . . [which they admitted] had been inoperative for some time, and the number was not answered when the Board's inspector tried to call it. Moreover, there was no functioning answering machine to provide an outgoing message as to where emergency services could be obtained. Additionally, there was an absence of notice that there was no 24-hour supervision of patients as mandated . . . Finally, the facility was found closed during nomral posted business hours, yet no referral was available for emergency services."

MAINTENANCE OF MISBRANDED OR EXPIRED DRUGS
(The truth of this charge was admitted by respondents Ronald Walker and Oasis Veterinary Clinic in the settlement)

The inspector found that "The pharmacy area was stocked with many expired drugs, which Respondents' employee indicated were routinely dispensed to the animals treated at [Oasis Veterinary Clinic & Hospital]. The controlled drug drawer was unlocked . . . The vaccine refrigerator/freezer had human food stored in it. The bulk liquids were stored in a cupboard with a mixture of spilled medication completely covering the bottom, cementing an old cardboard box and stuffed animal toy along with the bottles to the bottom of the cupboard. There were several bottles of liquid medication pre-packaged with only a drug name on them. These bulk and expired drugs which were either expired or so oldthat the expiration dates of the drugs could not be read, and the stuffed animal which was adhered to the medication spilled in the cupboard . . . The sale of expired prescription drugs is prohibited by law."

VIOLATION OF HEALTH AND SAFETY CODE
(The truth of this charge was admitted by respondents Ronald Walker and Oasis Veterinary Clinic in the settlement)

The inspector found that Oasis Veterinary Clinic's "x-ray developer is a hand-dipping tank, and was set up to have the chemicals drain into a pipe connected to the public sewer system. The x-ray waste generated . . . contains a silver-conten levfel that exceeds that which may properly be disposed of into the public sewer, and [Oasis Veterinary Clinic did not] have a contract with a licensed company for the disposal of their x-ray waste, or otherwise provide for the proper disposal of Respondent's x-ray waste in accordance with applicable law."

[ Oh, great! Threats to human health, as well!]

FAILURE TO PROVIDE MEDICAL RECORDS ON DEMAND (The truth of this charge was admitted by respondents Ronald Walker and Oasis Veterinary Clinic in the settlement)

" . . . The Board initiated an investigation based on a consumer complaint submitted by a consumer, Ms. J. J. on July 10, 2007. The complaint stated that on June 20, 2007, Ms. J.J. took her 5-year old Miniature Pinscher, Rex, to [Oasis Veterinary Clinic] for a neutering procedure and [he] ended up dead. As part of its investigation, the Board requested that [Oasis] produce the medical records for Rex. [Oasis Veterinary Clinic] failed to do so and later reported that the records for Rex were 'shredded' and destroyed . . ." [An Oasis employee later] "informed the Board's inspector that notwithstanding Respondent's requirements to maintain animal records fore a minimum of three years, [Oasis Veterinary Clinic] had a practice of destroying old records, including records of animals that died, such as Rex."

Violent Nutcase Vet Jeffrey Baranack Still Practising: Another Vet with Anger Management Issues!

If this doesn't make your stomach turn, I don't know what would.

In February of 2007 the Ohio Veterinary Board issued a "Notice of Opportunity for Hearing" to Jeffrey Baranack, DVM, of Oakpoint Veterinary Care in Dover Ohio. In this notice, the Ohio Veterinary Board listed 15 ALLEGED violations. Of these 15 allegations, 12 involved violent behavior toward patients.

For some reason (perhaps the nature of the violations? or is it the SNAILS PACE of state government?) it was not until March of 2008 -- over a year later -- that a Consent Agreement, detailing the disciplinary action against Baranack, was issued and signed. As a part of that consent agreement, Jeffrey Baranack "knowing and voluntarily" admitted violations related to 6 of the original allegations -- all of which involved violent behavior toward patients.

For my legal protection, I must say the following: the allegations that were not admitted to remain simply allegations. I am listing all of the violations alleged by the Veterinary Board in it's original notice below. The ones that Baranack admitted to are so noted.

ALLEGED VIOLATIONS (from the original hearing notice).

"1. On October 5, 2006, you treated 'Catalina' Hursey, a corgi mix. Although 'Catalina' was not behaving poorly, you allegedly repeatedly shoved her and yelled at her.

. . . .

2. On July 18, 2006, yu treated 'Chloe' Galmish. Although 'Chloe' was not behaving poorly, you allegedly repeatedly shoved her. . . .

3. On June 19, 2006, you treated 'Luke' Brown for an eye problem. While examining 'Luke' you allegedly yelled at him and roughly shoved his head. . . .

4. On April 25, 2006, you were taking a hip x-ray of 'Lakota' Smith. You allegedly began yelling and throwing things in the room and slammed 'Lakota' on the x-ray table. . . .

5. On May 19, 2006, you treated 'Bear' Murray for a mass on his nose. You allegedly punched and hit 'Bear' repeatedly, while yelling at him, causing blood from the mass to splatter on the wall." [VIOLATIONS RELATED TO THIS ALLEGATION WERE ADMITTED BY BARANACK]

"6. On August 11, 2006, you were to neuter a dog named 'Chopper.' You allegedly yelled at 'Chopper' and shoved him repeatedly. . . .

7. On August 20, 2006 you were treating 'Justice' Jeandervin when he barked at you. You muzzled the dog and allegedly told the owner that if he were your dog you would kill him and that he would have to be put down if he continued with this behavior. . . .

8. On November 2, 2005, you treated 'Pooh' Gardner for diarrhea. You allegedly hung 'Pooh' from the ground with a leash around his neck repeatedly until the cat went limp. 'Pooh' died a few days later and a necropsy revealed the cause of death as endocarditis and secondary pneumonia. You allegedly yelled at both the cat and the owners while doing this. Mrs. Gardner wrote a letter to the clinic complaining of your treatment of 'Pooh.'" [VIOLATIONS RELATED TO THIS ALLEGATION WERE ADMITTED BY BARANACK]

"9. On April 28, 2006, 'Theo' Shamel was brought in for euthanasia due to aggressiveness. You allegedly leashed the animal and had an assistant pull the leash tight around 'Theo's' neck while he was being pressed between the wall and door. When the staff complained you stated that you were going to kill the dog anyway." [VIOLATIONS RELATED TO THIS ALLEGATION WERE ADMITTED BY BARANACK]

"10. On November 28, 2005, you used a slip leash to get 'Oreo' Bennett out of his carrier. You allegedly then dragged 'Oreo' down the hall, bumping him into the exam room door, and used the leash to hoist the cat onto the surgery table." [VIOLATIONS RELATED TO THIS ALLEGATION WERE ADMITTED BY BARANACK]

"11. On February 23, 1999, 'Brownie," a terrier-mis, was in the clinic for diabetic blood work and a possible slipped disk. While examining 'Brownie' you allegedly muzzled and leashed the dog. You pulled the leash tight and 'Brownie' was panting and bleeding from his mouth with his front legs off the ground. You were yelling at 'Brownie.'" [VIOLATIONS RELATED TO THIS ALLEGATION WERE ADMITTED BY BARANACK]

"12. On March 22, 2005, 'Chloe,' a Jack Russell terrier, was in the clinic for blood work. 'Chloe' growled at you and you allegedly opened the cage. Using a broom you pinned 'Chloe's' head to the side of the cage and then repeatedly poked at 'Chloe' with the broom. Staff heard you yelling and saw the broom broken on the ground. You then muzzled 'Chloe' and removed her from the cage which was by then smeared with fecal matter. You kicked the dog repeatedly. Using a slip leash, you dragged 'Chloe' down the hall to an exam room. 'Chloe' stopped breathing and had to be intubated and resuscitated. The owners were called and told that 'Chloe' was unruly and needed to be picked up." [VIOLATIONS RELATED TO THIS ALLEGATION WERE ADMITTED BY BARANACK]

"13. On December 27, 2005, you performed a spay and front declaw on 'Sadie' Mullett. During this surgery you also filed down 'Sadie's' canine teeth. 'Sadie's' feet became swollen and she had a severe aversion to having her head touched or handled. 'Sadie's' paws required further treatment due to exuberant granulation tissue and dehiscence. A material thought to be surgical adhesive was found in each incision and had to be removed. 'Sadie's' teeth were filed down revealing the pulp and exposing the root. 'Sadie' underwent four root canals to correct the damage."

"14. You permitted Lori Murphy, an animal aide, to perform dental prophylaxis on patients in your clinic. Only a licensed veterinarian or registered veterinary technician is permitted to perform dental prophylaxis."

"15. You called in a prescription to Drug Mart for insulin for 'Sherman' Bennett. 'Sherman' is the patient at another veterinary clinic. 'Sherman's' owner did not want to take 'Sherman' for blood work. You do not have a valid veterinary-client-patient relationship with 'Sherman'. You do not have any records for 'Sherman' or any record of the prescription you called in."

The Consent Agreement does not cite violations related to allegations 1-4, 6, 7, 13-15 above, but the ones he admitted to (5, 8, 9, 10, 11, and 12) are bad enough.

So what did the vet board do?

They suspended his license for only 30 days.

They ordered him to take an anger management class, and to be assessed by a licensed psychologist or psychiatrist.

They ordered that he must be accompanied by a veterinarian or licensed technician for one year when he practices.

They put him on 3 years probation.

So, this is a guy whose history of violent treatment of patients goes back to 1999. Nine years.

Does the board really need a shrinks opinion?

If a pediatrician admitted to dangling children by their necks, would he still be practising?

If a person carrying out an execution order on a human pulled something tight around their necks and pressed them between a wall and a door before stopping all that violent nonsense to administer the lethal injection, what do you think would be done to them? Do you think they would still be working in that role?

WHAT IS WRONG WITH THE OHIO VET BOARD THAT THIS MAN IS STILL PRACTISING?????????

Links:

www.ovmlb.ohio.gov/minutes/Nov%2014%2007%20min.pdf

http://www.ovmlb.ohio.gov/compliance.stm

Alleged "Inhumane" Euthanasia via Insulin Overdose - Florida Vet Jay Butan of Lake Worth -- "Marley" of "Marley and Me's" Former Vet

"Marley and Me" is all the rage, but in some circles, it's sparking debate (because bloat, the condition for which Marley's owner had him euthanized, is TREATABLE in most cases and because their dealings with Marley's supposedly bad behavior, in the view of many, leave something to be desired).

In Grogan's book, he apparently calls Butan, Marley's first vet, "the doctor of our dreams."

Well, it seems that for at least one cat, and for a former colleague, Butan was the vet of their NIGHTMARES. "Marley's" first vet, Jay Butan, may not be such a great guy after all, no matter what author John Grogan says.

As some readers may know, my own beloved Toonces was given an insulin overdose at his vets. I saw some of the aftermath of that insulin overdose, and it was horrible and heartbreaking -- nothing you would ever want to see a pet go through. Therefore, when I read about Florida Vet Jay Butan, I became convinced that he is a MONSTER right up there with the likes of Bill Baber. Let me describe to you what happens when an animal receives an insulin overdose -- before it dies, if it dies.

First, the animal would experience:

". . . headache, irregular heartbeat, increased heart rate or pulse, sweating, tremor, nausea, increased hunger and anxiety . . ."

With a massive overdose, this would progress to severe effects on the central nervous system, including hypokalemia, hypophospatemia, hypomagnesia, and hypothermia. As the brain is deprived of glucose it needs to function, the animal will experience seizures and coma. Death will not come quickly, easily, or even surely. However, "massive necrosis," to quote my Toonces' neurologist, may result. That means death of brain tissue.

Does this sound like a humane method of trying to kill -- or euphemistically, "euthanize" -- a pet to you?

In the words of his former business associate and vet, Archie Kleopfer, who reported Butan: " . . . an insulin overdose leads to a slow, cruel, cold death. I still don't know why he went to the clinic in the middle of the night to kill animals with insulin".

Well, according to the Florida Vet Board, this is exactly what Jay Butan did -- use an insulin overdose as a means of killing a patient. On purpose.

Actually, in this article, it appears Butan admits it. Where are the animal cruelty charges against this, "Marley's" former vet?

Oh, that, plus engage in fraud in his business dealings.

The following is taken from the Administrative Complaint filed by the vet board against Butan (the fraud allegations come first):

"[Butan] and another veterinarian, Dr. Archie Lee Kleopfer, shared clinic space, an office secretary, and account management services, including credit cared service and common accounts."

"The office secretary observed unusual shortages . . . in Dr. Kleopfer's account."

"[Butan] explained the inconsistencies as 'A trade secret' and 'a computer re-indexing error' respectively. The missing monies were credited to Dr. Kleopfer's account on each following day."

"An accounting audit revealed that [Butan] embezzled at or around $27,447.14 by adjusting the accounts of both clinic clients and Dr. Kleopfer's. The account adjustments went back ten (10) years."

"[Butan] used an overdose of insulin to kill Spencer, an ill cat who lived at the clinic."

"Overdosing a patient with insulin is not an approved method of euthanasia. It is considered inhumane for purposes of euthanasia."

Editorial comment: Er, uh, it should be considered inhumane for ANY purpose!

"[Butan] failed to record within Spencer's medical records the method he died."

"[Butan] failed to record within the medical records of 'Taffy,' a dog who also lived at the clinic, the method he was euthanized." [sic]

The Board then cites Chapters 61G18-18.002(3) and (4) of the Florida Administrative Code, which address requirements for medical record-keeping.

The Board charged Butan with three counts:

Count 1: A violation of Florida Statute section 474.214(l)(m), by "fraudulently increasing several accounts payable"

Count 2: A violation of Florida Statute section 474.214(l)(o), "fraud, deceit, negligence, incompetency, or misconduct, in or related to the practice of veterinary medicine"

Count 3: A violation of Florida Statute section 474.214(l)(ee), "failing to keep contemporaneously written medical records as required by the rule of the board.

As you may be aware, veterinarians charged by their state boards usually choose to sign what is called a "consent agreement" or "settlement" in lieu of contesting the charges. As a term of these agreements, the vet never has to admit guilt, nor are the charges ever heard in court, so they forever remain allegations, and such is the case with the charges brought by the Florida Board against Butan. Butan, in signing a settlement, merely admitted that "the facts set forth [in the charges] . . . if proven, would constitute a violation . . ."

Butan was fined $2,000 and ordered to take "six (6) hours of continuing education in the subject area of euthanasia, anesthesiology or ethics."

Don't you think this man's license should have been taken away? Don't you think he should have been brought up on cruelty charges? I certainly do.

But not only is he still practising . . .

According to the Canal Animal Hospital website, of which he is now "President", his peers allow him membership in the Palm Beach County Veterinary Society, The Florida Veterinary Medical Association, and the freakin Chamber of Commerce.

What a role model.

And the Florida Vet Board apparently thinks he should still be able to get his hands on your pet.

LINKS:

Summary of Disciplinary Action -- Florida Board Minutes

Article on how Butan was Marley's vet, citing his violations and his admission of the insulin overdose

Alaska Denies Butan Request for Courtesy License to be Iditarod Vet (oh, that's a humane event . . . NOT!!). Note that Alaska cites Butan's failure to disclose Florida's disciplinary action on his license (proving that ETHICS are still an issue . . . ) ". . . for failing to disclose [the Florida disciplinary action] on his application as required by the statement 'I am not omitting any information which might be of value to this board in determining my qualifications and character . . . "

WATCH OUT!!!! Where is he now??

Butan's Profile at Canal Animal Hospital. Scary stuff.

Manta Business Listing

"Gross Negligence" in Arizona

This case involves "Flash," a 5-month old male Blue Point Siamese cat, who went into cardio-pulmonary arrest during what should have been a routine procedure -- a neuter and microchip implantation. The following is taken from the Findings of Fact issued by the Arizona State Veterinary Medical Examining Board. The veterinarian named in this case, and found by the board to have committed "gross negligence," is Denise Upchurch, D.V.M.

Flash's owners brought him to Upchurch on March 19, 2007. He was to be neutered and vaccinated the following day.

"'Flash' was examined the next day . . . noting a weight of 4 pounds 7 ounces, temperature of 99.9 degrees F, pulse > 200 BPM, and a respiration rate of 40 rpm. All else noted within normal limits. 0.3 metacam was administered orally, 0.5 mg acepromazine IM, 0.025mg atropine IM, and 1.0 torbugesic IM. Induction of anesthesia and maintenance wa3s by mask delivery of isoflurane. The timeframe between administration of the preanesthetics and delivery of isoflurane were not given in the medical notes. The concentration of the isoflurane for induction and maintenane was not documented in the medical record. A routine castration was performed, a microchip implanted, and a vaccination administered prior to cessation of anesthesia."

"After the microchip implantation, it ws noted that the mucous membranes were not pink and 'Flash' was not breathing. Manual breathing was started; however the patient proceeded into cardiac arrest. Cardiopulmonary resuscitation was performed to revive "Flash."

No intravenous catheter or supportive fluid therapies in the form of colloids or crystalloids were attempted because [Dr. Upchurch] indicated she was not authorized to do so."

However, they note:

"It is stated on the surgical release form that the client has been informed that there are risks and complications associated with any procedure and unforeseen conditions may arise that may necessitate the performance of additional procedures."

"Radiographs were performed to reveal an abnormal pattern which was attributed to manual ventiliation. 'Flash' remained on oxygen for twenty minutes while breathing regulated and the abnormal pulmonary sounds decreased."

"[Upchurch] contacted the cat's owner, advised him of the situation, and recommended transfer to a 24-hour facility. The owner was unable to leave work and elected to have the clinic continue hospitalization and callback in three hours to see if the cat would recover."

"At this point, 'Flash' was not placed back on mask delivery of oxygen. He was placed at the feet of the receptionist for visual observation. The only monitoring parameter recorded in the medical record between 1 p.m. and 4 p.m. (discharge) was at 2 p.m., and reported as 'breathing well, heart rate stable near 175 bpm."

"After two hours at 3:00 p.m. 'Flash' was semi-conscious, demonstrated opisthotonus, and showed no further signs of improvement. In the medical record it was noted a concern of hypoxia during arrest and brain injury. There was no indication of continued supportive care such as oxygen delivery or supportive fluid therapy. [Upchurch] recommended transfer to a facility for 24-hour care. 'Flash' was discharged at 4:00 p.m. into the owner's care for transport/transfer to Southern Arizona Veterinary Specialty and Emergency Center (SAVSEC)."

"Upon initial examination at SAVSEC, 'Flash' was hypothermic, non-responsive, and recumbant. An intravenous catheter was placed, crystalloid and colloid fluid support started along with thermal support, oxygen support, pulse oximetry, blood pressure monitoring, and hourly TPR (temp, pulse, respiration). 'Flash' made continued recovery with possible long-term visual impairment."

I presume that visual impairment would be from brain damage due to oxygen deprivation.

The board found that Upchurch's conduct "constitute[s] a violation of A.R.S. 32-2232 (11) for gross negligence for not placing an IV catheter to provide fluids and supportive care, including adequate monitoring to the cat after and during cardiopulmonary arrest."

Note: Although the Board document does not identify the business where Upchurch works, a web search finds a "Denise Upchurch D.V.M." at Feline Limited Cat Clinic in Tucson. If anyone knows if they are the same, let me know.

The Board placed Upchurch on 1 year probation and ordered her to take 6 hours of continuing education in critical care management.

Dog Dies After Sustaining Head Trauma at the Vets (Sonya McClendon, DVM, Marshall Texas)

This is one of those stories where a pet owner with a brain will read "between the lines." Keep in mind, that the veterinary board who acted in this matter pretty much recounted the VET'S VERSION OF EVENTS as though it were the truth. In the VET'S VERSION OF EVENTS the dog, a rat terrier named Star, "fell off the table and hit her head on the floor." She hit her head so hard that the damage sustained was so bad that she had to be euthanized. The vet claims the dog "fell off the table," even though she told the owner that (having been bitten by the dog), if the dog were hers she would have "beat the hell out of her."

So what do you think REALLY happened?

Here is the vet board's account:

In April, 2008, Star's owner brought Star in for coughing. "Dr. McClendon examined 'Star' and diagnosed 'Star' with bronchitis and tracheatis, possibly due to a bordatella infection. After the examination, Samantha Maxwell, a veterinary technician at respondent's clinic, attempted to administer Metacam orally with a syringe. 'Star' bit Ms. Maxwell on her hand, but she was successful on her second attempt. 'Star' was placed on a table in the kennel, where Ms. Maxwell attempted to medicate 'Star' with a Primor pill antibiotic. Ms. Maxwell was unable to administer the medication as 'Star' continued to snap at her. Dr. McClendon also tried to administer the medication, but was bitten in the process. Dr. McClendon subsequently used a pill pusher to successfully administer the medication. In the process, Star bit Dr. McClendon twice more. However, when Dr. McClendon pulled her hand back, 'Star' bit her on the thumb and would not release. Dr. McClendon slapped 'Star' on the muzzle several times in an attempt to get 'Star' to release her thumb. In the confusion, 'Star' fell off the table and hit her head on the floor."

"IN THE CONFUSION?????? IN THE CONFUSION?????" What the hell does that disingenuous phrase mean?

I'm guessing it means: "Oh, gee, somehow, we dont remember, the dog who was attached to my thumb -- who I was busy slapping -- ended up slamming to the floor and hitting his head really hard. Duh. Not sure how."

What do you think?

The document goes on:

"'Star' was then given a flea bath and placed in the kennel to dry. While drying in the kennel, 'Star's' nose began to bleed. [Star's owner] was in the clinic's waiting room while the medication was administered. While she was paying her bill, Dr. McClendon stated that Star had bitten her, and if it was her dog, she would have 'beat the hell out of her.' Dr. McClendon also said she did not want to see 'Star' at her clinic anymore, and [the owner] apologized. 'Star' was picked up by [the owner's] husband, at approximately 4:30 p.m. that day and presented with blood on her nose. A staff member of the clinic informed [the husband] that 'Star' had fallen off an examination table."

Keep in mind, at this point, these vets had Star for some time.

"Star's nose continued to bleed after returning home. At approximately 8:00pm that evening, [the owner] noticed that 'Star' had become letharghic. On the morning of April 3rd Star was still lethargic and her nose was still bleeding. She could not walk and was having difficulty breathing. At approximately 7:30 am [the owner] presented star to Jason Anderson, D.V.M., Marshall Animal Hospital, where a blood profile was conducted and radiographs taken. Dr. Anderson diagnosed 'Star' with severe head trauma. 'Star' suffered seizures while being examined, which left her 'non-responsive and in an apparent vegetative state,' and 'eventually went into cardio-respiratory arrest.' Once Dr. Anderson informed [the owner] of Star's status, she elected to euthanize Star."

Did you get the part about "SEVERE HEAD TRAUMA?"

The board stated:

"Dr. McClendon's failure to property restrain and administer medication to Star does not represent the same degree of humane care, skill and diligence in treating patients as is ordinarily used in the same or similar circumstances by average members of the veterinary medical profession in good standing in Marshall, Texas or similar communities. Specifically (1) Dr. McClendon's failure to property restrain Star during the administration of medication, (2) her failure to allow Star's owner -- who was present in the clinic waiting room -- to administer the medication to Star, rather than to administer it herself and (3) her failure to recognize that Star's continuing nosebleed subsequent to her fall . . . " [editorial comment: Yeh, fall. Right. Some "fall."] ". . . was a sign of head trauma and treat accordingly, led to complications which ultimately contributed to the untimely death of Star."

CONTRIBUTED TO?????

Hmmm. About that comment Sonya McClendon made. That comment that if Star were her dog, she would "beat the hell out of her." Maybe it wasn't a hypothetical????

And you gotta wonder -- does Dr. McClendon HAVE ANY DOGS? ANY PETS AT ALL? If she does, shouldn't someone go remove them from her custody, given her assertion that she finds justification to "beat the hell out of" her dogs, as well as given the fate of Star?

Poor Star.

Star, if there is a heaven, or any kind of justice in the afterlife, you will 150 pounds and giant, and Dr. McClendon will be 15 pounds and tiny. And she will be delivered to you on a silver platter, for you to so with as you wish.

Alas, in this life, you were a victim.

A veterinary victim.

How did the veterinary board deal with McClendon?

They gave her a big scary FORMAL REPRIMAND.

They fined her $500.

They ordered her to take a class in animal behavior. (Um, how about anger management?)

They ordered restitution of a measely $111.82. Which McClendon had apparently had the gall to charge Star's owners.

Do you think this is enough for the life of your dog?

Moreover, this was not the first time McClendon had been disciplined by the board, nor the first time her actions had been implicated in the death of a patient. See below.

All of that -- and does the board take her license? No. Do they give her so much as 1 day active suspension? No.

Way to go coddling those repeat offenders, Texas. How many dogs will she have to kill before you take some real action?

Thank you to Texas Citizen Greg Munson of the Texas Vet Board Watch and Texas Veterinary Records site for calling my attention to this case.

To view the disciplinary record on which this entry is based, go here


UPDATE: Bad Vet Daily has just found out that Sonya McClendon, the vet in this case, allegedly supports the breeding of cats with deformities, providing veterinary services to a breeder called "Karma Cats". See http://www.ripoffreport.com/reports/0/059/RipOff0059206.htm. Many people believe this to be a cruel and perverse operation. For more debate, see http://www.angelfire.com/yt/twistykats/

Also, this is not the first death in the hands of McClendon in a case disciplined by the vet board. In a 2004 case, it was found that McClendon "failed to administer fluids to a dehydrated patient" and to that patient, simultaneously administered two contraindicated drugs -- rimadyl and banamine. The dog in question died two hours later. The board described that in that case, she was "annoyed" that she had to see the dog -- who came in on an emergency basis, and who was not her regular patient. In that case, the board "formally reprimanded" her.

Here is the case: http://texasveterinaryrecords.110mb.com/TX_2005_Mcclendon_Sonya_2005-05.pdf

Vet Carlton Cuts Up and Cremates Dead Patient Without Owners Permission, Without Notifying Pet Owners of their Pets Death

Virginia Veterinarian Carlton Elam is living proof that the disciplinary actions of the Virginia Board of Veterinary Medicine are useless as a deterrant to future violations. How else can you explain a history of violations going back over 25 years?

Moreover, his most recent violation also raises the question: What is a veterinarian trying to hide when he cremates a dead patient without ever notifying the owners that their beloved dog has even died?????

Ask yourself:

If a human died in the hospital, and the attending physician performed an autopsy and then cremated the person, all without ever notifying the family of the death, would that phsyician still be practising?????

This is not the first time I've heard of this kind of thing happening at a veterinary practice. In fact, years ago, I heard a similar story from a veterinary hospital receptionist working here in the Washington DC area: At the practice where she previously worked, she boarded her dog for the weekend. The only thing wrong with her dog was that he was taking Deramaxx for arthritis. When she returned to the hospital she was told that her dog was dead. He had died that weekend while in the "care" of unlicensed, unsupervised veterinary assistants. They refused to allow her to see the body, telling her it would "upset her" too much. They cremated the dog without her permission and handed her a box of ashes.

I would like NOTHING MORE than to give the name of the animal hospital at which she said this occurred; however, for my own legal protection, I cannot do so. However, I can tell you that the hospital was one where the owner had disciplinary action taken on his license in a different case, and one I have written about. Unfortunately, the former staff member never filed a complaint with the vet board or took any other action against the vet, so there is no public record on the case involving the death of her dog. This places me at liability if I name the hospital, whereas if there were public record of this having occurred, I could name the hospital. One more reason you should REPORT these kinds of things. Also, since that hospital had other complaints against it and prior disciplinary action, her reporting of this incident might have resulted in stronger action being taken against them as repeat offenders. Sadly, like so many victims -- particularly those who also work in the veterinary field and are afraid of being "blacklisted", she did not file a complaint. So they blithely go along till this day doing things like that, I'm sure.

Therefore, my deep gratitude goes to the owners of "Bumpie," a dog who fatefully died in the care of Virginia Veterinarian Carlton Elam. You see, they DID file a complaint with the vet board, and THERE IS PUBLIC RECORD which can be republished to warn others about this man. But does it make a difference anyway? Do vets even pay attention to disciplinary actions of the vet board -- unless the vet board actually does something serious like enforce a license suspension or revoke a license? Apparently not . . . which brings me back to Carlton Elam.

What happened to Bumpie? Why did he die at Elam Veterinary Hospital in Powhatan, Virginia? And . . . do Elam's actions after Bumpie's death give us a clue that perhaps Elam was trying to cover something up? Judge for yourself.

In an order dated December 1, 2008, the Virginia Veterinary Board states in its findings of fact that "On February 8, 2008, [Dr. Elam] failed to notify the owner of Bumpie that Bumpie had died the night before."

"Following the discovery of Bumpie's death, Dr. Elam performed a necropsy without obtaining the permission of Bumpie's owner or allowing said owner the option of having the necropsy performed by another veterinarian."

"Dr. Elam arranged for the cremation of Bumpie's remains without receiving permission from Bumpie's owner."

"Dr. Elam failed to record the cremation of Bumpie's remains in the medical record."

Why did Bumpie die? Will we ever know? Don't ask what the necropsy showed, unless you just fell off the proverbial turnip truck!

But this was FAR from Dr. Elam's first violation. And so, the Veterinary Board -- citing the fact that at the time Dr. Elam committed these acts, he was already on probation as a result of a prior Board order (which required him to maintain a "course of conduct" commensurate with the requirements of the code), found him in violation of their prior order, and placed him on "idefinite probation" for a period of not less than 3 years. They reprimanded him and fined him $1,500. But what are the terms of the probation? Will this keep Dr. Elam from doing such a thing?

Apparently not, because he was already on a 3-year probation when he did this!

So -- WHEN EXACTLY -- does the Virginia Veterinary Board suspend or revoke a vets license for violating probation? Can a vet simply continue to commit such acts over and over, and simply get an extended probation each time? Seems so.

You see, in January, 2008 -- just one month before Elam necropsied and cremated Bumpie without even telling the owners he'd died -- The bet board had fined Elam $10,000 in another case. YOU ALMOST NEVER HERE OF A FINE THAT HIGH. They also had said that within a year of that action, they would conduct an unannounced inspection of Elam's facility. Did they?

In their order, dated January 28, 2008 -- mere days before poor Bumpie died under Elam's care only to be necropsied and cremated before his owners found out -- the Board said:

" . . . On or about January 16th, 2006 . . . Client A presented to his practice with 'Coconut,' a canine who was not eating well and was constipated. Dr. Elam documented in Coconut's records that he prescribed 10 mg of prednisone to be taken twice a day for neck pain. On or about January 30, 2006, Coconut was returned to Dr. Elam's practice having lost approximately two pounds and still was not eating. On February 4, 2006, Client A presented with Coconut who was eating small amounts of food. Based on bloodwork, Dr. Elam diagnosed Coconut with Addison's disease."

Over the next several months, Coconut's owners continued to bring her in to see Carlton Elam, and she continued to lose weight.

In early June, however, Coconut's owners apparently finally took her to another vet, who diagnosed Coconut with "hepatocellular carcinoma." The Board said:

"Dr. Elam overprescribed the amount of Prednisone administered to Coconut for treatment of Addison's disease, and failed to diagnose Coconut's carcinoma . . . Although Coconut continued to decline, Dr. Elam failed to offer to refer Client A to a Veterinary Internal Medicine Specialist."

So, Coconut's owners seem to have lost nearly 6 months between the time Coconut exhibited illness and the time they got a correct diagnosis from another vet. Time they could have spent treating Coconut for her cancer, instead of overdosing her with prednisone.

In their original letter to Elam requesting that he attend a conference to review allegations against him, the veterinary board stated that Elam never conducted an ACTH test to confirm his Addison's diagnosis. According to AddisonDogs.com an ACTH test is necessary to confirm diagnosis of Addison's. If Elam did not do this, was he giving Coconut large quantities of steroids for a disease she didn't even have??? According to AddisonDogs.com, "The Merck Veterinary manual recommends a prednisone dose of 0.1 – 0.2 mgs/lb. per day." If Coconut was getting 10 mg twice a day, that is 20 mg per day. That would be an appropriate maximum dose for a 100 pound dog. And that's only if she DID have Addison's -- which it seems was a misdiagnosis. Was Coconut a 100 pound dog???? If not, what are the consequences of a prednisone overdose? According to Wedgewood Pharmacy, "Chronic or inappropriate use of corticosteroids, including prednisone, can cause life threatening hormonal and metabolic changes"; also side effects include: "polyuria, polydipsia, polyphagia, poor haircoat, GI disturbance, diarrhea, vomiting, weight gain, GI ulceration, pancreatitis, lipidemia, elevated liver enzymes, diabetes mellitus, muscle wasting, and possible behavioral changes." Corticosteroids suppress the immune system. What effect would that have on the survival of a dog with cancer?

As I mentioned, the Board fined Elam $10,000 in that case. This is an unusually high fine, and I believe the reason was . . . he had a long history of violations including:

1983 -- Found in violation of State regulations when he induced labor in a horse and then left her. "There was a difficult delivery, and the foal was born dead." The Board fined him $250.

2002 -- The veterinary board found Elam had failed to maintain adequate records in the case of two patients, "Tor" (dog) and "Christmas Pie" (cat). They fined him $500. However, in my opinion, this appears to be a case in which much more serious things occurred, but the Vet Board just found him guilty of the "lesser" violation of recordkeeping. This is one of the sneaky things Board's do to protect vets. Why do I think this? Because the Vet Board's Notice of "Informal" conference includes allegations that that Elam may have engaged in unprofessional conduct and provided substandard care. This is stated in the Board's notice telling Elam to come to an "informal" conference to discuss the complaint. This notice includes the following information:

"You performed medical tests and procedures, some unnecessary, on your patient "Tor" . . . without obtaining the client's authorization and discussing additional charges. Further, you failed to appropriately diagnose "Tor," and you failed to maintain adequate and complete patient records for him." They go on to give the following specifics:



They go on to say:

"You performed or had performed numerous tests on Tor, some unnecessary, without Client A's authorizatin, in that Client A discussed euthanizing Tor with you upon his admission on November 6, 2000. Additionally, when Client A noted "Tor's" condition was deteriorating on November 7, 2000, she told you she did not want to keep "Tor" alive if he was not going to get better. You denied that Client A ever mentioned euthanasia to you and stated that you provided 'only minimal diagnostic testing and treatment to stabilize "Tor." In fact, billing records indicate you performed internal parasite examinations on November 6 and 7, 2000; complete blood counts on November 6 and 7, 2000, and two (2) blood chemistries on November 7, 2000 in addition to the one performed on November 4 by another veterinarian before "Tor" expired on November 7, 2000."

I remind the reader that the above was included in the ALLEGATIONS, not in the findings of fact, and that the findings of fact do not include substandard care or unprofessional conduct. They include only recordkeeping violations. The question is: WHY??????

These allegations go on to state:

"You performed unnecessary medical tests on your patient, "Christmas Pie" . . .further, you failed to adequately diagnose "Christmas Pie" and failed to maintain accurate patient records for her. Specifically . . . Client A presented Christmas Pie to you for teeth cleaning. Your records indicate that "Christmas Pie" weighed 8.1 pounds, and you administered anesthetic according to that weight.[emphasis added]. "Client A provided previous and subsequent records indicating the weight of the cat has remained stable at approximately 6 pounds prior and subsequent to your December 22, 1999 treatment of her . . . Client A again presented "Christmas Pie" to you on or about July 31, 2000, with symptoms of frequency of urination and excessive thirst. At her request, you performed tests to determine whether the cat had decreased kidney function. Althouth you performed tests that you indicated ruled out anemia, you failed to adequately diagnose the cat's condition or provide a treatment plan after performing additional tests. Further you performed tests based upon your belief that "Christmas Pie" had lost two pounds since December 22, 1999, despite Client A's assertion that the weight you recorded in December was incorrect."

2003 -- The veterinary board investigates a complaint against Elam, and finds no "clear and convincing" evidence that he committed violations.

This, IN SPITE of the fact that the notice available online prior to the board's finding of "no violation" include the following allegations:

" . . . . on April 15, 2002, Client A presented to your practice with "Chloe," a puppy, for a routine spay. You spayed Chloe and sent her home the same day. [The next day] Chloe's sutures ruptured allowing her intestines to be exposed. You took Chloe back into surgery and repaired the incision, but Chloe died later that night. You failed to properly suture Chloe's incision during the initial surgery."

After Elam's history of repeated complaints and findings . . . he still is allowed to practice by the State of Virginia. Here is a screenshot from the Veterinary Board website showing the long list of documents associated with investigations and disciplinary actions taken against Elam:



When will the Virginia Veterinary Board put an end to Elam's trail of tears?

Links:

Order in the Case of Bumpie

Order in the Case of Coconut

Allegations in the Case of Chloe

Order in the Case of Chloe

Order in the Case of Tor and Christmas Pie

Allegations in the Case of Tor and Christmas Pie

Order in the Case of the Dead Foal

WARNING: This vet also goes by the name of Nick Elam and C. Nick Elam.