Monday, April 6, 2009

"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.