Saturday, March 15, 2008

Multiple Instances of Bad Vettery on the Part of Paul Deal in Maryland

Veterinarian Paul Deal, owner of Countryside Animal Hospital in Oakland, Maryland, is one of few veterinarians who have wracked up multiple Board disciplinary actions in just the last few years.

The three cases involve Deal's treatment of Angel the Cat; Porky, the Irish Wolfhound; and Zoey, the Labrador.

These cases also show how the Maryland Board gives the vets the benefit of the doubt when they claim they did something, but there is no proof of it in the record. Because repeatedly, when there is no record of Deal doing something he SHOULD have done for a patient, intead of finding him in violation of regulations for NOT doing that thing, they simply find him to have violated record keeping statutes -- in other words, they assume he did it but just didn't write it down. A vet could CLAIM ANYTHING, make up any fiction, and the State Board would take his word for it, but just assume that he failed to write it down. This behavior on the part of the Maryland State Board violates a fundamental precept in medical record-keeping: If it isn't written down, it didn't happen. But the Boards -- even when disciplining vets -- bend over backwards to believe their versions of events, no matter what the client and the records say. I have a little bit of personal experience with this phenomena.

The Case of Zoey the Labrador

In summer 2005, Zoey's owner brought Zoey -- a 6-year old Labrador -- in to see Dr. Deal after Zoey had reportedly jumped out of a window and broken her left front leg.

The Board document states:

"Dr. Deal examined Zoey after assuming her care, but he did not record his findings in the patient's record (excepting the notation that the dog weighed 72 pounds). In answering [the owner's] complaint against him with the Board, Dr. Deal states that, after physicially examining Zoey's left front leg, he discovered a fracture at the distal end of the radius, bu found the skin to be intact. Assuming this statment is true, Dr. Deal failed to record this and other pertinent information in the patient's record including, but not limited to, the dog's temperature and pulse."

"Dr. Deal did not radiograph Zoey's front leg that night. He did administer morphine to the dog, and then confined her in a cage for the night."

[OK, do you not find this ridiculous? How can you properly and thoroughly characterize a break if you do not take x-rays? Why did he not take x-rays until the following day?]

"On or about the following day, Dr. Deal radiographed Zoey's leg, entering the following notation in the patient's record: 'X-ray radius/ulna - fx [fractured] distal radius and ulna with overriding.' Dr. Deal, however, did not describe the fracture to [Zoey's owner] after radiographing Zoey's leg. Likewise, Dr. Deal did not obtain [Zoey's owner's] consent before proceeding with his plan to manage the dog's fractured leg, that being: performing a closed reduction and external coaptation."

Um, yeah, I had to look that up -- it's surgery. He didn't talk to the owner to get her consent to do this surgery, she probably didn't even know he was doing it.

The Board continues:

"Dr. Deal examined Zoey before anesthetizing the dog and performing the surgery upon her, but he did not record his findings in the patient record."

Um, if he didn't record anything in the record, how do they know he adequately examined her before anesthetizing her???? Just because he SAYS SO, right? This is a good example of how the Board believes what the vet says in the absence of evidence, knowing very well the vet could be lying, and I am certain that in general, the vets often do lie and SAY they did thing they know they should have done, but did not do, or vice versa. The deck is stacked against pet owners because these boards -- vets themselves -- just believe whatever unsubstantiated crap flows out of these vets mouths.

"Likewise, following surgery, Dr. Deal did not record in the patient's record the progress and disposition of the case."

Hey, BOZO board. Maybe the reason he didn't record anything is because he wasn't even monitoring the dog, ever occur to you?

"On or about the same day, Dr. Deal dischared Zoey to [her owner's] care. If Dr. Deal instructed [Zoey's owner] on how to care and manage Zoey until such time that the dog could be seen by her regular veterinarian, Dr. Deal did not record this event in the patient's record."

So, after all that, what did the Board find that Dr. Deal did wrong?

RECORDKEEPING VIOLATIONS. Penalty = $500 and a STAYED suspension (which is a meaningless paper suspension -- not 1 day of work missed). They also gave him 6 months probation, but the only conditions of probation are not to violate regulations, which is a silly condition since it is a condition that always applies to all vets all the time, there is no punitive element to it.

The Case of Porky the Irish Wolfhound

In spring of 2004 Porky's owner brought Porky, a 4-year old Irish Wolfhound, in to Dr. Deal because Porky was having seizures.

The Board document says:

"In answering [Porky's owner's] complaint against him with the Board, Dr. Deal provided a short history of Porky's condition as it pertained to the dog's medical status; that being: Porky had been previously treated for seizures by a veterinarian in Ohio, but was no longer receiving this treatment (if [the owner] informed Dr. Deal of the particular treatment that the Ohio veterinarian had prescribed (e.g., the amount and frequency of any medication provided), Dr. Deal did not note it). Dr. Deal also provided his initial diagnosis of Porky's condition; that being: Status epilepticus."

"In the record . . Dr. Deal did not provide the aforementioned short history of Porky's condition as it pertained to his medical status. Likewise he did not provide his initial diagnosis."

"Assuming Dr. Deal thoroughly examined Porky (phsyically and neurologically) when the dog was first presented, excepting his weight and that the dog was having trouble breathing, he did not record his findings in the patient's record, including, but not limited to, the dog's temperature (the failure to record and monitor Porky's temperature is particularly problematic because increased temperatures commonly occur in dogs with status epilepticus.)"

". . . Dr. Deal administered diazepam [valium] intravenously to the dog, and made the following comment in the patient's record: "achieved desired effect" - suggesting that the medication had terminated Porky's seizure activity. Dr. Deal, howeer, provided no details in the patient's record documenting that this had actually occurred." [Then how in the world do we know that it did occur?] "That same day Dr. Deal also provided a two week supply of Phenobarbital at a dosage of 64 mg BID (less than the recommended dosage of 2-8 mg/kg BID.) If this dosage was the maintenance dosage that the Ohio veterinarian had prescribed to treat Porky's seizure problem, Dr. Deal did not note this in the record." [Why would they assume that when it is the wrong dose -- an inadequate amount? Porky weighed 100 pounds. That is 45.36 kilograms. If the Board's statement that the recommended dose of this drug is 2-8 mg/kg, then Porky's dose should have been a minimum of 90 mg, up to 362 mg.]

"On Monday, June 14 . . . Porky paid a return visit to Dr. Deal. In the patient's record for this date, Dr. Deal noted that Porky reportedly had repetitive seizures over the weekend. Another entry suggested that Dr. Deal may have examined Porky that day. Assuming this examination occurred, however, Dr. Deal did not record his observations in the patient's record." [Then how do they know it occurred? Becase he says so?]

"Dr. Deal did renew the Phenobarbital prescription that day, but failed to specify in the patient's record how much medication was dispensed, and thus, how long the medication should continue."

" . . . Dr. Deal made no entries in the patient record stating how the dog's seizure disorder was responding to the prescribed treatment."

What did the Board find him on?


The Case of Angel the Cat.

Angel was a 5-year old cat. Angel's owner brought her into Dr. Deal's hospital because he had a urethral obstruction.

The Board document says:

"If Dr. Deal examined Angel that day, after assuming the cat's care, he did not record his findings in the patient's record (excepting the notation that the cat weighed 10 pounds)."

"After removing the obstruction, Dr. Deal expressed the cat's bladder completely. Dr. Deal made the following notations in the patient's record concerning the cat's post-surgical condition: "urine very bloody," "severe cyanosis developed after the bladder expressed," [cyanosis is when you turn blue from lack of oxygen!], "responded to intubation and room air resuscitation," "tomcat catheter intalled and left overnight," "Metacam overnight for pain." Dr. Deal did not record the dosage of Metacam that Angel received."

OK -- here is a big thing. Metacam is an NSAID -- non-steroidal anti-inflammatory drug. This drug should be used with GREAT CAUTION in cats if at all. The veterinary information network says "the wrong dose of meloxicam [Metacam] can be very dangerous for cats"; it also says:

"It is also important that NSAIDS not be given to dehydrated patients because of this potential side effect [of reducing blood flow to the kidneys]. This is particularly true in cats."

I mention this because the board document notes that Dr. Deal "did not administer fluid therapy to Angel"; this combined with the Metacam is very concerning for a variety of reasons. The Board document says:

"failure to administer subcutaneous fluid to an obstructed cat to correct subclinical dehydration, meet maintenance fluid requirements, and keep up with losses from potential post-obstructive diuresis, constitutes substandard care."

"On the following day, Dr. Deal discharged Angel to [her owner] . . . " On or about June 23, 2005, Angel was returned to Dr. Deal. "Dr. Deal's notations in the patient's record concerning this visit consist of the following remarks: "SICK" [no duh -- did you go to vet school to be able to render such brilliant diagnoses?]; "bladder is not emptying properly but no plugged - expressed bladder with no resistance," "healthy appearance to urine - owner insisted on taking patient home against advice," "recheck tomorrow.' If Dr. Deal physically examined Angel on that date, he did not record his findings in the patient's record."

OK dear reader, am I the only one who suspects a little retroactive notations in the record here?

This guy didn't write anything down in the records -- doesn't record the patient's vitals, doesn't record things hardly at all anyway as the Board says, but somehow, he produces a record that says "owner insisted on taking patient home against advice" once a complaint has been filed against him? Do you smell some CYA going on?

This record doesn't tell you what happend to Angel, but I am betting that he died. Being giving potentially kidney toxic metacam while being given no fluid support as sick as he was -- that doesn't bode well.

The Board found Deal yet again in violation of a slew of recordkeeping counts, and one instance of substandard care for failure to give Angel fluids.

For these two cases (Porky and Angel) Deal was fined $1,700 and got a stayed suspension for 2 weeks -- again, meaningless; it is a paper-only suspension and the vet loses not ONE minute of work; and he was placed on probation for 6 months, but that too is meaningless, since the only condition of probation is that he pay the fine he already has to pay and that he not break any regulations -- which apply to all vets at all times - so HOW is that a condition of probation?
"Don't break the laws you shouldn't have broken in the first place?"

Another Bad Sign about Deal and his practice: The entire practice apparently -- according to the website -- consists of him, his wife, and his daughter. Bad sign. Exactly what kind of objective third party testimony do you think is every going to be given by other people at that practice? Do you think they cover for each other?