California Veterinarian Larry Romine Ordered to Surrender License; Veterinary Board Alleges Romine Committed Negligence; Botched Spay

Yet another botched spay story from California.

In June, 2007, veterinarian Larry Romine was ordered to surrender his license in the State of California to settle a complaint brought against him by the veterinary board. As a part of the settlement agreement, Romine admnitted that the Board "could establish a factual basis for the charges in the Accusation" if further proceedings were conducted. These charges dealt with Romine's treatment of a 5-month old rat terrier female named "Roxy."

Roxy's owner brought Roxy to the Kaweah Veterinary Clinic, operated by Romine, in Visalia, California, to have her spayed.

Two days after hte surgery, Roxy's owner brought her back in to the clinic, because Roxy was lethargic and unsteady on her feet. The staff at Romine's clinic told her that "Roxy's condition was likely due to the affects of the anesthesia, and she was instructed to prevent Roxy from drinking any fluids for the remainder of the day."

But the next day, Roxy was worse. In distress, she was vomiting any time she tried to drink fluids. Her owner then took her to a different clinic -- an emergency clinic.

The examination revealed "a build up of fluid in her abdomen, with indications of kidney damage."

The next day, Roxy was seen at yet another hospital, for more evaluation and testing. Exploratory surgery was done on Roxy, and they found that Roxy appeared to have been born with only one kidney, and that a three-inch section of the right ureter (which carries urine from the kidney to the bladder) had been surgically removed "during the same surgical procedure removing her right ovary, right ovarian horn, and uterus." In other words, when he did the "spay", Romine cut the ureter leading from Roxy's ONLY kidney.

In addition, the document said, Roxy's left ovary and left ovarian horn were still intact. Which means that not only was she butchered by having her right ureter cut, but the spay wasn't even finished.

Not that the latter issue mattered much, because "due to the inability to repair damage to Roxy's one kidney and ureter, she was euthanized."

The board asserted that Romine had commited negligence, both in removing the section of the ureter, and in not removing the left ovary and left ovarian horn.

In addition, they said that another element of negligence was that Romine had "failed to recognized symptoms consistent with post-surgical abdominal pain and clinical depression" when Roxy was brought back to him after the spay.

(Gee, "depression????" I'd be depressed too, if someone cut my only ureter . . .making it impossible for my body to clear urine and essentially causing me to be unable to continue living. Depressed? Ya think?)

In addition, when Roxy was brought back to him after surgery, he "failed to perform a physical exam" on her.

Other "causes of dicipline" cited by the board included their failure to make entries in Roxy's record describing the surgical procedure performed, the sedatives or anesthetics used, and the name of the surgeon who did the butchery, uh, I mean, operation.

Other record keeping violations were cited.

In addition, the board said that an inspection of the hospital showed that Romine:

Did not have a dedicated froom for surgery;
Did not have emergency drugs or equipment in the room where surgeries are performed;
Did not have a notice telling clients that 24-hour supervision is not provided;
Did not dispose of expired drugs; he did not record the names of patients or prescribing veterinarians in the drug log;
Did not have a properly functioning anesthesia machine in the surgery room;
Did not have an autoclave device (for sterilization);
Did not wear appropriate attire in the surgery room;
Did not enter his initials on exam records;
Did not have equipment for monitoring patients under anesthesia in the surgical room;
Had stored "products intended for human consumption" in the surgery room refrigerator.


The board noted that Romine had previously bee cited for failing to comply with minimum standards of veterinary care.

Arizona Veterinarian Barbara Guminski May Have "Ligated Both Ureters" During Spay; Dog Euthanized When Can No Longer Urinate; Court Absolves Vet

For this post, I must remind ALL readers that the things I say here are MY PERSONAL OPINIONS based on review of publicly available documents. In this case, I think Barbara Guminski -- an Arizona Vet -- is a BAD VET. Apparently, so did the notoriously lax Arizona Veterinary Board, when they heard a complaint against her in 2002, and subsequently found her in violation of the Veterinary Practice Act. However, the Superior Court of Arizona -- specifically, the "Honorable" Judge Michael Jones -- did not agree with the Board (and does not agree with me that BARBARA GUMINSKI IS A BAD VET). But surely, if you are a concerned pet owner, you can't read the account of this case and ever feel comfortable allowing her to operate on your pet . . . CAN YOU????

Well you shouldn't, because not only is this case horrifying, but it's not the first time that EVEN THE notoriously lax Arizona Vet Board decided Guminski had violated standards.

Take a look:

http://www.superiorcourt.maricopa.gov/SuperiorCourt/LowerCourtAndAdminAppeals/docs/adminAppeal/a/LC2003000387001DT.pdf

In 2002, owners of a Great Dane took their pet to the Spay and Neuter Clinic, where "Dr." Guminski was working, to have their pet spayed. Since this dog is not given a name in the court document, for the sake of having a reference, I will refer to her as "Lovey" -- for I am sure, to her owners/pet parents, that is what she was.

So, they took "Lovey" the Great Dane to be spayed by "Dr." Guminski.

The following morning, "Lovey's" owners took her to an emergency clinic, where she was seen by a vet named Jackman. Dr. Jackman noted that "Lovey" was not urinating.

The following day, "Lovey's" owners took her back to the Spay and Neuter Clinic, where they saw a different vet -- Dr. Morrison. "Lovey" had not urinated since the surgery. She was also ill.

According to the court account, Morrison confronted Guminski, saying that he was concerned that Guminski might have tied off both the ureters by mistake.

Jackman performe surgery, and found that "Lovey's" kidneys were enlarged, and there was no urine in her bladder. (Apparently, the ureters carry the urine to the bladder from the kidneys . . . )

He recommended that "Lovey's" owners euthanize her to spare her suffering, and they did.

They also filed a complaint with the vet board.

Now, getting the Arizona Vet Board to take action against a vet is no small feat. Arizona's Vet Board is notoriously awful, from a consumer perspective. To get a clear picture of exactly how bad the Arizona Veterinary Board is, getta load of this -- taken from the wonderful (though heartbreaking) website, http://www.aligus.com. The references to the "Audit" refer to the State's review of the Veterinary Board's effectiveness:

"In the Arizona audit, the dismissal rate of complaints had been as high as 90 percent. Veterinary consultants retained by the Auditor General of the State of Arizona reviewed complaints from fiscal year 1996 and found that as many as one out of every six complaints dismissed should have resulted in some discipline. The Board dismissed a complaint against a veterinarian who inserted a feeding tube into a cat's lungs instead of its stomach. The cat died when food was injected through the tube. The Board dismissed a complaint against a veterinarian who euthanized a dog without the proper consent. In a Board meeting, even though the veterinarian admitted making the error, the Board still dismissed the complaint.
Source: http://www.auditorgen.state.az.us/PAD/97-7s.htm.
Since January 1, 1998 more than half of the complaints before the Arizona Board were dismissed. In an average year, one license is revoked and usually this is for drug abuse by the DVM, not animal mistreatment. Most penalties are for failure to notify the board of an address change. Only two Tucson-area veterinarians faced probation or more serious discipline in the past five years for animal care or client interaction. The board's own records are incomplete, inconsistent and inaccurate
Source: http://www.azstarnet.com/star/sun/30629VETS2f2fdst-jmd.html, June 29, 2003 "

Here is the piece of information on the Arizona Vet Board that I find most damning, taken directly from the report which can be found at
http://www.auditorgen.state.az.us/Reports/State_Agencies/Agencies/Veterinary%20Examining,%20State%20Board%20of/Performance/97-07/97-7.pdf

"While investigating one complaint, the Board investigator found that the veterinarian in question was euthanizing animals with household bleach and other cleaning chemicals, and disposing of the animals in plastic bags while they were still alive. Although the investigator submitted a report regarding these allegations in December 1995, Board members were not made aware of this situation until it was brought to their attention by auditors in November 1996 . . . a review of the investigation file in 1997 found no evidence of investigative action [in this case] since December 1995."

So, I'm figuring you need to have pretty compelling evidence to move the Arizona Vet Board to action, and it is no small feat getting them to do so.

So, back to the Vet Board's findings in the case of "Lovey." The vet board found that Guminski violated the practice act, specifically, sections of the Practice Act related to Unprofessional or Dishonorable Conduct (A.R.S. 32-2232), subsection 11, pertaining to "Malpractice, gross incompetence or gross negligence in the practice of veterinary medicine."

They voted to place Guminski on probation for 4 years, and to order her to take 28 hours of continuing education.

Quite conservatively, I believe, the Board stated in it's decision that:

"Tying off the ureters during a routine spay is below the standard of care since tying off ureters is not part of a spay."

Wow. Understatement of the century. Kinda akin to:

"Piercing both of the patients lungs during heart bypass surgery is below the standard of care since piercing both of the patients lungs is not a part of heart bypass surgery."

So, Guminski -- who had already admitted she may have "ligated" [tied off] "Lovey's" ureters, appealed this decision.

And won.

In making her argument on appeal, the court document indicates, Guminski argued that "Lovey" bled SO MUCH that she couldn't see what she was doing. She called the bleeding "irrepressible." She said she had to "feel" her way around in "Lovey's" abdomen, rather than rely on sight -- presumably implying that is how she may have made the mistake of tying off "Lovey's" ureters carring urine from her kidneys to her bladder rather than the uterine horns she was supposed to tie off.

She also said that when she saw "Lovey" was bleeding this much, she "called for her technician to scrub-in" and attempt to assist her in "controlling the bleed."

Question 1: Why was she doing this surgery withouth a technician already scrubbed in to assist?

Question 2: Was this individual licensed?

Question 3: If no one was there but her and her "technician", why does the Dishonorable Judge Michael D. Jones take this account as FACT? This account of her being faced with SO MUCH IRREPRESSIBLE bleeding that she couldn't see what she was doing?

The court document also states as a fact that Guminski told the owners to take "Lovey" to an emergency clinic for overnight monitoring. I wonder whether or not the owners account sustains this assertion? Or is this another case of Courts accepting as fact the word of a vet against a client EVEN when there is a dead dog on the table [figuratively]?

Essentially, the Dishonorable Judge Jones found that because "Lovey" bled so much, it wasn't a "routine spay" saying: "An abdomen flooded by an incessant bleed, to the extent that a veterinarian surgeon has to use her hands to feel for ligatures, is far from a 'routine spay.'"

OK, I'm an idiot layperson too, and even I can see how stupid that statement is. The ligatures were what she was SUPPOSED to place on the uterine arteries, NOT the things she needed to feel for. She was allegedly "feeling" for pieces associated with the reproductive tract and found ureters instead. Not ligatures. Which wouldn't have been there until she put them there. ON THE URETERS, supposedly, which is not where they were supposed to go.

Jones stated that the "standard of care" was "not relevant" to the "emergency situation" faced by Guminski. Presumably, or rather -- Guminski's account verified only by Guminski herself and the "technician."

Emergency. Standard of Care Irrelevant. Remember those words, and forever associate them with the names of the Dishonorable Michael Jones and the Bad Vet Barbara Guminski.

Hey, how about a Bad Judge Daily. Any takers?

Of particular interest: Guminski apparently tolerates no rebuke from the Vet Board.

In 1999, Guminski was placed on probation by the vet board, as the result of a complaint filed about her treatment of a cat. Guminski asked for another hearing and the Board denied her. Then, Guminski filed for judicial review of the Board's decision to deny her a rehearing. The trial court dismissed her complaint for untimely filing, and she then appealed that decision as well, but the appeals court said "we find no merit in her argument."

Does she seem like a weasely sort of person to you? She does to me. She will say anything to get out of being held accountable, won't she? I bet that is why she says "Lovey" was bleeding so badly she couldn't see.

Oh -- no, not weasely. That's the wrong word. It's an insult to weasels. Sorry, cute little weasels. Maybe . . . slimy? Unnaccountable? Irresponsible?

A web search on Guminski associates her with Bethany Animal Hospital in Phoenix.

Links:

http://www.superiorcourt.maricopa.gov/SuperiorCourt/LowerCourtAndAdminAppeals/docs/adminAppeal/a/LC2003000387001DT.pdf

http://caselaw.lp.findlaw.com/data2/arizonastatecases/app1/cv/cv000446.pdf

Other Links:

http://www.vetmed.lsu.edu/eiltslotus/Theriogenology-5361/canine_surgery.htm
Quote: "If you ligate both ureters, the dog will go into anuric renal failure."

http://www.petplace.com/cats/hydronephrosis-in-cats/page1.aspx

http://www.x-cd.com/therio06/pdfs/1.pdf
Quote: "Accidental ligation of a ureter, which can result in hydronephrosis or atrophy of the kidney, is easily preventable by careful identification of the uterine horns, uterine body, and cervix prior to ligation of the uterine body, and avoidance of ligation of any extraneous peribladder fat which may contain a ureter."

http://veterinaryrecord.bvapublications.com/cgi/content/citation/139/19/471

Other cases where vets ligated ureters:

http://www.lsbvm.org/news_04_04.htm
http://badvetdaily.blogspot.com/2008/02/negligence-in-nevada.html

http://www.cvm.uiuc.edu/courses/vcm667/labs/abdom_ug/127900.html
X-rays of a dog who had one ureter ligated (tied off during a spay); it's right kidney had to be removed.

Interesting Vet Student Discussion which Includes the Issue of Ligated Ureters:
http://forums.studentdoctor.net/showthread.php?p=6157433