Tuesday, August 5, 2008

Michigan's Khalid Tirmizi: "Negligence or Failure to Exercise Due Care . . ."

In January 2007, The Michigan Board of Veterinary Medicine entered into a Consent Order with Michigan Vet Kalid Tirmizi, as the ultimate result of a complaint filed against him in May 2005. Ironically, this very Consent Order simultaneously said that the Disciplinary Subcommittee "finds that the allegations of fact contained in the complaint are true,;" while nontheless dismissing one of the two allegations in the complaint. ??? How do you dismiss an allegation that you find to be true???? OK . . . .

As for the substance of the complaint . . .

Tirmizi was practising as a vet at Bloomfield Pointe Veterinary Hospital in Pontiac Michigan.

On November 21, 2003 . . . [dramatic pause for effect here . . . these events took place in 2003, and this order was signed in 2007. WHAT TAKES SO LONG???] . . .

"a. At approximately 2:30 p.m., a six-year-old feline owned by J.G. . . . presented to the Facility with a blue tongue, respiratory distress of unknown etiology and drooling from the mouth. The feline had been a patient of [Bloomfield Pointe Veterinary Hospital] for six years. [Tirmizi] performed a minimal physical examination and administered .25 cc of acepromazine along with atropine, dexamethasone, oxygen and intravenous fluids.

b. At approximately 6:00 p.m., [Tirmizi] called J.G. requesting that he pick up the feline because the facility was closing and it did not have overnight care available.

c. When J.G. arrived at [Bloomfield Pointe Veterinary Hospital] [Tirmizi] demanded payment for veterinary services performed and advised J.G. that he should euthanize the feline or take it to Oakland Veterinary Emergency Group, hereafter Oakland, in Bloomfield Hills, Michigan.

d. Subsequently, J.G. brought the feline to Oakland. Upon arrival at Oakland, a physical examination was performed and a chest x-ray was done. After a diagnosis of severe pulmonary edema and heart failure, efforts to stabilize the feline failed and the feline was euthanized on November 22 at approximately 2:30 a.m."

OK, so before we read what the board decided, let's think about all of this.

Tirmizi performed only a MINIMAL exam on a cat having so much difficulty breathing that his tongue was blue. Since he didn't perform a thorough exam, do x-rays, etc. then I assume he didn't know the cat was in heart failure. Which is not a good thing, because pets in cardiac failure have a difficult time processing fluids. And Tirmizi put this cat on fluids. Ultimately, the cat had severe pulmonary edema. Now, I don't know for sure, but I surmise that the IV fluids Tirmizi would have made pulmonary edema worse if the cat had it already, or even could have caused it in the case of heart failure.

I have no idea why he gave the drugs he gave (dexamethasone, acepromazine, atropine) but one thing is for sure: None of these appear in the recommended treatments I've found for heart failure in cats.




Now for what the Board found:

In their original complaint, the board said that:

Count 1: Tirmizi's "conduct, as set forth above, evidences a violation of general duty, consisting of negligence or failure to exercise due care, whether or not injury results, in violation of section 16221(a) of the Public Health Code . . . "

Count 2: Tirmizi's "conduct, as set fort above, evidences a departure from, or failure to conform to, minimal standards of acceptable and prevailing practice for the health profession, whether or not actual injury to an individual occurs, in violation of Section 16221(b)(i) of the Public Health Code."

However, when they entered into the Consent Agreement with Tirmizi, which wasn't signed until January 2007, they dropped/dismissed the second "standard of care" violation, in spite of language in the beginning of the document which states (without specifying exceptions) that "the allegations of fact contained in the complaint are true . . ."

For the remaining violation (negligence statute) they fined Tirmizi $1,000 and put him on probation for a year.

Links and references:

Michigan Bureau of Health Professions Announces Disciplinary Action against Tirmizi -