Wednesday, March 12, 2008

Careless Vet's Use of Ketamine Without Evaluating Feline Patient "Falls Below the Standard of Care" in Maryland

Veterinarian Dennis Foster owns Dundalk Animal Hospital in Baltimore, Maryland. In summer of 2005, "Kitty", a 12-year old male cat, was brought by his owner to Foster on an emergency basis.

According to the records, "Kitty had been losing weight for several weeks and was constipated. The entries also state that Kitty was 'weak, dehyrated," had a temperature of 100F, weighed 11.5 pounds, and that his pelvic outlet was swollen."

Dr. Foster didn't write anything in the records about feeling a "mass" in Kitty's colon, but AFTER the owner filed a complaint against him, he told the Board that when Kitty was brought to him "a ten inch rock-hard mass was palpated in the [cat's] colon." The Board stated that Dr. Foster did not record Kitty's respiratory rate and "other pertinent information that should have been noted describing the cat's physical condition at the beginning of custody."

The Board document says:

"Dr. Foster administered four enemas and fluids to Kitty. Dr. Foster, however, failed to note in the patient's record the volume and type of fluid that was used to administer the enemas. Similarly, Dr. Foster failed to record the volume and type of fluid that was used to administer fluid therapy to the cat."

[Hmmm. He never wrote it down, but NOW, after a complaint has been filed, he says he did it. Do you believe him now?]

The document goes on to say that Foster told the Board that "the enemas were not successful in removing the colonic mass." But the Board says that Dr. Foster failed to record this information at the time.

Here is where it gets more shocking:

"Despite Kitty's age and condition at presentation, Dr. Foster performed none of the standard routine diagnostic tests indicated in these circumstances (e.g. complete blood count, serum chemistries, and urinalysis) to help ascertain the underlying cause of the cat's constipation and existence of any complicatiosn due to the constipation (e.g., electrolyte abnormalities)."

Apparently, Foster kept Kitty overnight, because the document says:

"For July 19, 2005, the patient's record specifies that Kitty was 'still constipated.' To relieve the impaction, Dr. Foster determined that manual removal of the colonic mass was necessary. To perform this procedure, Dr. Foster sedated Kitty, using Ketamine."

What in the heck are they talking about here? SURGERY? This is what I mean about these board documents -- they obfuscate what occurred. Did he tell the owner he was going to perform this "procedure?"

The Board says: "Ketamine is a controlled dangerous substance. It also is a rapid-acting agent. Its pharmacologic action is characterized by profound analgesia, immobilization, normal pharyngeal-laryngeal reflexes (which, because they remain active, may lead to and increase laryngospasm, bronchospasm, and coughing), mild cardiac stimulation, and respiratory depression. Ketamine also has the potential to increase respiratory secretions, which may cause the airway to become obstructed.

"For these reasos, before administering Ketamine to an animal, standard veterinary care requires the veterinarian to examine the animal and evaluate its condition. In this case, given the cat's condition and the fact that Ketamine is excreted from the kidneys, the examination and evaluation called-for in these circumstances should also have included an assessment of the cat's renal function."

"Dr. Foster, however, failed to perform such an evaluation. If he did, he did not note this in the patient's record."

"On July 19, 2005, Dr. Foster also administered one enema to Kitty."

[WHAT???? On top of the "procedure" he did this? ]

"Dr. Foster, however, again failed to note in the patient's record the volume and type of fluid used for the enema. Dr. Foster also administered fluids to Kitty. Although he did identify in the patient's record the type of fluid that was administered to Kitty (to wit: lactated ringers solution), Dr. Foster failed to record the volume administered."

"Dr. Foster did note in the patient's record that he was able to remove 85% of the colonic mass."

[During the "procedure'????]

"Assuming the cat was being monitored after he performed this procedure, Dr. Foster failed to record Kitty's progress and response to treatment in the patient's record. Excepting a notation (for what appears to be July 20, 2005) indicating the cat's temperature to be 100F" [this is subnormal by about 2 degrees], "the patient's record contains little, if any, information about the cat's condition. This is the case for both July 19, 2005 (when Dr. Foster was still present at the hospital) and July 20, 2005 (when the cat was discharged, and the day on which Dr. Foster's assistant - Dr. Terrence Maskol - also assumed care of this animal). For example, in his written response to [the owner's] complaint, Dr. Foster notes that his assistant, Dr. Maskol, recommended on July 20, 2005 that Kitty remain hospitalized, but there is nothing in the patient's record explaining why he had made this recommendation."

The Board found Dr. Foster in violation of recordkeeping requirements on several points. But as a discerning reader might perceive from reading this, it seems that more serious things than recordkeeping violations may have taken place. When a vet doesn't write things down, nothing is in the record, BUT LATER, after a complaint is filed, he claims he did certain things, it is HIGHLY suspicious.

They also found Foster in violation of the standard of care, saying:

"Given Kitty's age and condition . . . " Dr. Foster should have perfomed standard diagnostic tests.


"Given Ketamine's pharmacologic action and the fact that it is excreted from the kidney's, and given the age and condition of the cat (to whit: Kitty's stated weight loss, dehydration, anorexia, and weakness, conditions that result from renal failure), in failing to evaluate the cat before administering this drug, including assessing the cat's renal function Dr. Foster's care fell below the minimal standard required of a veterinarian in this State."

Obviously, this Board document leaves some glaring questions, most importantly:


What motivated the owner to file the complaint, and why is kidney function repeatedly emphasized? Did Kitty go into acute renal failure after this "procedure" and after receiving the Ketamine? Did Kitty die?

Clearly, BOTH of these things COULD HAVE resulted from Foster's actions, which in my viewpoint are careless.

Do you see how you have to read between the lines on these Board actions?

What happened to Foster as a result of these violations????

Well, his license was suspended for ONE month -- BUT, the suspension was STAYED. That means, not enforced -- he missed not one day of work.

He was placed on probation for six months and ordered to pay a penalty of $2,100.

But WHAT became of Kitty?