Saturday, January 24, 2009

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 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, "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?


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.