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.

http://members.aol.com/jchinitz/hcm/treatmnt.htm

http://www.2ndchance.info/cardiomyopathy-cat.htm

http://www.petplace.com/cats/congestive-heart-failure-in-cats/page1.aspx

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 -
http://www.michigan.gov/documents/mdch/mdch_dar_020207_187694_7.pdf

Michigan Vet Michael Curley: Vet Board Says He Altered Records, but Dismisses 2 Out of 3 Charges

This is the kind of unreal, outrageous things vet boards do:

On the one hand, they affirm that their allegations against a bad vet -- in this case, Michigan Vet Michael Curley -- are true. On the other hand, they SIMULTANEOUSLY DISMISS CHARGES AGAINST HIM.

It's convoluted: Let me see if I can help you follow it. Hopefully, at the end of the story, you will see what I see: A slimy vet, and a spineless vet board that rolls over and wallows in the slime rather than protect their state's beloved pets.

On March 28, 2007, the Michigan Department of Community Health, acting for the Michigan Board of Veterinary Medicine (the "vet board") filed a complaint against Michigan vet Michael Curley, of the Red Barn Veterinary Clinic in Grand Rapids, Michigan.

In this complaint, the vet board said (emphasis added):

"On June 13, 2006, [Curley] performed an initial examination of an 11-year old German Shepherd with a history of degenerative myelopathy, and dispensed non-steroidal anti-inflammatory drugs. [Curley] failed to document the chief complaint, examination results, or reason for dispensing medication."

"On July 31, 2006 [the Vet Board] received an allegation against [Curley] which included a copy of the canine's medical records from the clinic."

"On October 5, 2006, pursuant to a signed release, [Vet Board] received a copy of the canine's medical records from the clinic. A review of the records indicated that [Curley] had altered the canine's medical records to indicate that the examination was a second opinion and that x-rays and bloodwork were recommended."

As a result of these assertions, the alleged the following violations:

"Count I: [Curley's] conduct, as set forth above, evidences a violation of general duty, consisting of negligence or failure to exercise due care, including negligent delegation to or supervision of employees or other individuals, whether or not injry results, in violation of section 16221(a) of the Public Health Code . . . "

"Count II: [Curley's] conduct, as set forth above, evidences a departure from, or failure to conform to, minimal standards or 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 . . ."

"Count III: [Curley's] conduct, as set forth above, evidences a lack of good moral character, in violation of section 16221(b)(vii) of the Public Health Code . . . "


Are you with me? You get what the Board was saying in this complaint?

Think they were saying that Curley ALTERED records . . . oh wait, that was the exact word they used, "altered" -- we don't have to guess, that IS what they were saying.

Why would a vet do that? To COVER HIS ASS in a veterinary complaint? Ya think? Ya think that would make him UNETHICAL??????

So get this -- The Vet Board's disciplinary subcommitte then entered into what is called a "Consent Order" with Curley. It means that both parties (the Board and the Vet) agree what will be done as a result of the complaint.

In this Consent Order, the Board says that Curley AGREES that the Disciplinary Subcommittee will treat the allegations as TRUE, but that he doesn't admit to them. The document goes on to say that "IT IS HEREBY FOUND that the allegations of fact and law as se forth in the complaint are true . . . "

YET, in the same document, while affirming the truth of the allegations in their complaint, the Board DISMISSED their charges of violations in Counts I and III of the Complaint, (the ones pertaining to lack of good moral character and negligence). They only issued action on Count II, which was the one pertaining to standard of care.

Is your head turning on its axis? The allegations are true . . . but we are dismissing charges. Does that make any sense to you?

I guess it shows how seriously the Vet Board takes altered records.

Yes, they fined him $750.

They put him on probation for six months.

They ordered him to take continuing education in veterinary recordkeeping.

(I wonder if the name of that class is: "How NOT TO GET CAUGHT the Next Time You Alter your Patient Records to Cover your Ass."

What do YOU think of the practice of vets altering patient records?

Would you go to a vet who did such a thing?

Resources (I can't vouche for these -- Just some things to read . . . )

Support group for families of dogs with degenerative myelopathy:

Degenerative Myelopathy Support Group

Ideas on Treating Degenerative Myelopathy

Yahoo Group

Michigan Vet Tamara Dawn Lynch: Felony, Drug Diversion

I don't know where how to classify this, but I am tempted to classify it under the infamous "Vets with Anger Management Issues" category. It might also be classified under the category of "blink and you'd have missed it" enforcement actions by state boards.

In October 2006, Michigan Vet Tamara Lynch was "disciplined by the [Veterinary] Board's Disciplinary Subcomittee . . . [for] prescribing medications for herself using her cat's name, and failing to maintain appropriate veterinary records."

In February of 2007, Lynch was convicted of Assault with a Dangerous Weapon for trying to run her ex-husband over with her car. Well, the Vet Board document says she "attempted" to do this, but the court document (charges) says:

"Count 1: Assault with a dangerous weapon (felonious assault)
[Lynch] . . did make an assalt upon George Haynes with a dangerous weapon, to-whit: a motor vehicle, but without intending to commit the crime of murder or to inflict great bodily harm less than the crime of murder."

For this, Lynch was placed on probation for 2 years and fined a mere $720.

The Veterinary Board in Michigan is required to suspend the license of vet's convicted of a felony. The public health code says (emphasis added):

"If a licensee or registrant is convicted of a felony . . . the department shall find that the public health, safety or welfare requires emergency action and, in accordance with sectin 92 of the administrative procedures act of 1969, shall summarily suspend the licensee's license or the registrants registration."

So, as required, the Board issued an order of "summary suspension" on Lynch's license. In the Board's administrative complaint, it also referenced the prior violation of Lynch -- prescribing drugs under her cats name which she took herself.

In its administrative complaint, May 24, 2007, the Board stated that the felony conviction "evidences a lack of good moral character . . . ."

Yet, in a document stamped June 12, 2007 -- about 3 weeks later the Michigan Department of Community Health requested that the summary suspension be DISSOLVED. They declard that Lynch was not a threat to public health, safety, or welfare.

In January, 2008, the Veterinary Board entered into a mutually voluntary consent agreement with Lynch, in which they agreed to keep Lynch's license on probation for 2 years or until her criminal probation was over. In stating its reasons for this decision, the Board said:

"Respondent submitted to a psychological evaluation that was done shortly after her convictoin, with supporting documentation reflecting that she is not a threat to the public. It should be noted that the conviction was not based on a patient-care related issue. Respondent has completed an anger management class and several continuing education courses."

So -- here is the question I have.

Experts have demonstrated that people who abuse, lash out at, attack, torture, [fill in your verb of choice] animals go on to do this to people. For a good explanation of this, see http://www.pet-abuse.com/pages/abuse_connection.php.

Why wouldn't the Board be concerned that this connection also goes the other way -- if someone lashes out in anger at a person, tries to run them over with a car, should we not also be concerned that they may lash out in anger at animals? And when their jobs involve handling -- often alone and without witnesses -- the most vulnerable beings, the most vulnerable patients of all, ones who CAN'T later tell you what happened to them -- how could they summarily declare that this person is not a "threat" to health and wellbeing?

Who knows why she did this to her ex. Maybe he cheated on her.

Well, what if your pet gives another staff member more attention than it does to her? Will she hit him?

Maybe they had an argument over money.

If one of her clients has difficulty paying a bill, or argues with her over charges, will she accidentally-on-purpose assault their animal?

Or - heaven forbid -- a scared animal who is in pain and doesn't understand what is being done to him or her should actually growl, hiss, or bite Ms. Lynch. What then????????????? How will Ms. Anger-Management-Issues vet react then? With no one watching? And a patient who can't talk about it later?

Oh, and don't forget that little bit about her writing prescriptions for her cat for drugs that she herself was taking. That was before she tried to run her husband over with a car.

Anyway, is this vet a chance YOU want to take?

A web search today shows a "Tamara Lynch" working at Animal Emergency Hospital in Macomb, Michigan. I can't promise you its the same person, but it seems like a good guess.

Links:

http://www.animalemergencyhospital.net/wst_page2.html

http://www.michigan.gov/documents/mdch/mdch_dar_011108_222294_7.pdf

Update:  Lynch Response to this Blog.    I am adding this link to permit interested parties to read the response posted by Lynch.  My posting this link in my mind does not negate the foregoing, albeit, the blog on Tamara Lynch above is not anywhere near one of the worst that appears here, and as she pointed out, does not deal with a patient care issue (although, anger management and drug diversion are big enough concerns for me if I were considering a vet, but each of us must make our own decisions).  However, the way Tamara Lynch chose to deal with the comment/opinion etc. on this blog is reasonable.  If you are unhappy about anything posted here, or on a review of your business, common sense and decency might tell you that the best way to deal with it is to answer it, and in doing so, acknowledge errors or mistakes made.  If your clients have given your business bad reviews, you need to ask yourself why and search yourself for the reasons.  And address them.   Most importantly, identify, acknowledge, and address clearly any quality of care issues at your practice, and implement monitoring to make sure that you keep your word to address them.  Attacking clients is not a good PR strategy.  Neither is threatening them with lawsuits.  It's called free speech, and you have it too.   I think by telling her own side of things on a site she maintains, she is responding to this in a constructive way. Perhaps by adding this link, her blog will get the search results bump she's been seeking for her response to be seen.

Multiple Violations in One Year for Michigan Vet, Abolarin Agbona of "Comprehensive Animal Clinic" in Lansing

In 2006, the Michigan Veterinary board filed two administrative complaints against Comprehensive Animal Clinic's (Lansing, Michigan) owner and veterinarian, Abolarin Agbona. In both cases Agbona was found by the Board to have committed acts of negligence and substandard care; in one of these cases the "unsanitary conditions" of Comprehensive Animal Clinic were found to violate public health code.

Case 1: The Case of Zippy the Cat

The Board's administrative complaint states the following:

"On March 23, 2005, at approximately 8:00 p.m., a feline named Zippy presented to [Agbona], who diagnosed Zippy with urinary blockage. [Agbona's] documentation concerning his treatment of Zippy was inadequate. Specifically, Zippy's medical records showed no indication of physical examination findings, history and route of medications administered. The medical records also lacked a summary of x-ray findings, urinalysis results, or procedures performed."

"On March 25, 2005, when Zippy was picked up from the clinic by its [sic] owner, Zippy was covered in urine and feces. Thereafter, Zippy continued to experience problems urinating and the owner sought treatment for Zippy from another veterinarian."

"On September 14, 2005, Complainant's investigator conducted an inspection of [Agbona's] clinic and found that [Agbona] failed to store controlled substances in a securely locked cabinet or maintain an accurate inventory of controlled substances. Complainant's investigator also noted a strong odor of urine and feces upon entering the clinic, and found uncapped needles and syringes on hallway countertops and overflowing Sharp's containers. Complainant's investigator further found that the refrigerator/freezer in the clinic stored medications, but also contained foods intended for human consumption."

The Board found that Agbona's conduct "evidences a violation of general duty, consisting of negligence or failure to exercise due care, including negligent delegation to or supervision of employees or other individuals . . . [and] evidences a departure from, or failure to conform to, minimal standards of acceptable and prevailing practice for the health profession . . . " They also found that "the unsanitary conditions of [Agbona's clinic]" violated the public health code.

Case 2: The Case of Koda the Ferman Shepherd
(Do you think they mean GERMAN shepherd? The Board document definitely says "Ferman . . ." Wow, brilliant . . . )
The Board document states that:

"On February 8, 2006, at approximately 10:30 p.m., a Ferman Shepard [sic] named Koda presented to [Agbona] on an emergency basis with symptoms of "bloat."

"On February 8 and 9, 2006, [Agbona] provided substandard treatment to Koda, and [his] documentation concerning his treatment of Koda was inadequate to determine the seriousness of the dog's condition. Specifically, [Agbona's] documentation lacked any mention of fluid therapy, electrolytes, or acid-base evaluations in the medical records. [Agbona's] x-ray of Koda was of poor technial quality so as to render it totally useless, and he failed to refer Koda to another veterinarian. Furthermore, [Agbona] failed to document the results of a gastric lavage." (Gastric lavage meaning pumping out the stomach -- http://en.wikipedia.org/wiki/Gastric_lavage.)

"On February 9, 2006, Koda's condition continued to deteriorate and the dog's owners sought treatment for Koda with another veterinarian, who diagnosed Koda with gastric-dilation/volvulus (GVD)" (GVD is bloat.)

The Board found that Agbona's conduct "evidences a violation of general duty, consisting of negligence or failure to exercise due care, including negligent delegation to or supervision of employees or other individuals . . ." and that Agbona's conduct "evidences a departure from, or failure to conform to, minimal standards of acceptable and prevailing practice for the health profession . . ."

So, could the failure to diagnose and properly treat Koda for bloat have cost him his life?

It could have, although we do not know whether or not it did, because the board document doesn't say what happened to Koda.

But according to this website (http://www.allpetsmacomb.com/emergencies.html):

"Gastric dilatation volvulus (GDV) or "bloat" is a condition in which the stomach
enlarges with gas and flips/rotates on itself. This results in an increasing amount
of gas that cannot be released from the stomach, respiratory compromise, shock, and
death. Any dog with rapidly increasing abdominal size, respiratory difficulty, and
vomiting or attempted vomiting, should be examined by a veterinarian immediately. . .

"Rapid diagnosis and treatment is essential to a successful outcome.
IV fluids, medication for shock, and surgery to relieve the torsion and empty the gas are necessary for dogs with GDV."

Another website (http://www.animalemergencyservices.com/Canine_Conditions.aspx) says:

"[Bloat]is a life-threatening condition. . . Failure to rapidly treat this condition will result in your pet’s death."

I know if I lived in Michigan, I would NEVER darken the doorstep of "Comprehensive Animal Clinic" or any other place this vet ever worked!

Links: http://www.michigan.gov/documents/mdch_dar_060206_164522_7.pdf