This entry is about Richard Springer, of Brandywine Animal Hospital in Clinton, Maryland.
In early 2005, an owner brought "her dog 'Baby,' a four-year old male Yorkshire Terrier, to Dr. Springer for veterinary care, believing that her dog was constipated. According to the Veterinary Board's charging documents, in her complaint against Dr. Springer, [the owner] noted that Baby had been 'acting strangely' and yelped whenever he was picked up. In his written response [to the complaint] Dr. Springer noted that Baby was presented for 'pain.'
"In his written response to [the complaint], Dr. Springer also noted the following: (a) Baby had never been to his office and had no history of being seen by a veterinarian in two years; (b) On physical examination of Baby, the noted 'a large fecal mass in [dog's] posterior colon"; (c) On visual examination of the dog's oral cavity, he noted a 'moderate tartar accumulation on most teeth, gingivitis, and probable periodontal disease'; (d) He could not obtain an accurate body temperature for the dog rectally; (e) Because of the dog's medical history, he made a differential diagnosis of canine disk diease, and decided to take an abdominal radiograph;" . . .
OK, pay attention to the next part . . .
"(f)Baby 'defecated and urinated freely and became temperamental when placed in a right lateral [recumbant position]; (g) Baby 'bit freely into the X-ray gloves'; (h) He noted that the radiograph was 'negative for obvious disk disease,' but showed a large air density in the [dog's] posterior colon;' and (i) He made '[a] diagnosis of colonic obstruction due to fecal impaction," and injected cortisone for inflammation, and then discharged the dog."
The Board goes on to say that the information Dr. Springer provided in response to the complaint did NOT appare in the patient record. They say that Springer did not record Baby's medical history and condition, did not record his diagnosis, did not record his treatment or the medications given to Baby, and did not record the "progress and disposition" of the case.
They further noted that Springer failed to meet standards for taking x-rays. Specifically they said that "For diagnostic purposes, a minimum of two radiographic views is highly recommended. For radiation safety purposes, the radiography should be limited to the specific area of interest. Neither standard was met . . . "
The Board adds -- pay attention here, and ask yourself what the implications are . . .
"Dr. Springer noted that Baby was an excited, fractious patient. In such cases, tranqualization or sedation of the animal may be necessary, unless contraindicated, to secure the radiographs, patient comfort, and handler safety."
So -- since he did get x-rays -- how then, did he get this fractious patient to lie in the right position and hold sufficiently still without any sedative? And what might his method of achieving this have to do with Baby's fractured jaw - if anything at all?
The Board continues:
"Having diagnosed that Baby was suffering from colonic obstruction due to fecal impaction, Dr. Springer's workup should have included a more focused examination to rule out colonic, rectal, or prostatic pathology. In the absense of an underlying disease, treatment should have included digital evacuation of the rectum-colun an/or administration of mild enemas. Dr. Springer has not provided any information indicating that he performed any of these procedures. Dr. Springer administered cortisone to treat inflammation, but such drug may have been contraindicated under these circumstances."
The Board also notes that Springer made no plan to treat the periodontal disease he identified.
The document goes on to say:
"When [the owner] went to the hospital's kennel area to help retrieve Baby from his cage, she noted that her dog's mouth was bleeding and in an open position. [The owner] asked Dr. Springer about this, and he told her that Baby was "Okay," that the dog had just cracked a tooth. If Dr. Springer examined Baby's mouth, he failed to note the severity of the injury the dog had sustained."
"After arriving home, Baby would not eat or drink . . . [the owner] also noted that that dog was unable to close his mouth. [The owner] called Dr. Springer and informed him of this problem, and asked that he examine her dog. Dr. Springer directed [the owner] to take Baby to Southern Maryland Referral Center located in Waldorf, Maryland."
The owner took Baby to another hospital, where the vet told her that Baby had a fractured jaw. He was sent to an emergency clinic where a "mandibular fracture" (broken jaw) was repaired.
Most of this detail does not appear in the "Consent Agreement," however.
The Board fined Springer $1,850. They suspended his license for 2 weeks, BUT STAYED THE SUSPENSION, which means that NOT ONE DAY of the suspension was enforced.
They placed him on probation for 6 months, but that probation is pretty meaningless, since the only term of the probation is to obey the regulations he already should have been obeying in the first place.
So -
How did Baby's jaw get broken?
And why did Springer tell Baby's owner that Baby was "Okay" and only had a cracked tooth when she arrived at the vet hospital to see her dog Baby bleeding from his mouth which was apparently hanging open?
Did Springer really not KNOW that Baby's jaw was fractured? (How unobservant, or ignorant, would he have to be not to know that?)
Or did he know it but just not say?
If the latter, why? Does it have anything to do with uh, Baby's "fractious" ness?
Showing posts with label Maryland State Board of Veterinary Medical Examiners. Show all posts
Showing posts with label Maryland State Board of Veterinary Medical Examiners. Show all posts
Friday, August 29, 2008
Thursday, April 3, 2008
Crazy B.S. Vet Boards Believe [or, rather, PRETEND they believe]: The Case of Daniel Peck of Maryland and Shelby the Pug
This case, from Maryland, provides a really good example of how veterinary boards always believe the veterinarian when the owner's account and the vet's account are diametrically opposed, even when the suspicious behavior of the veterinarian seems to indicate that the owner is telling the truth.
For example -- don't you think you would know whether or not you told a vet, or gave permission to a vet, to spay your dog? If you thought a vet was just going to remove a lump on your dogs leg, but your dog came out of surgery having had an entire spay performed, wouldn't you be mighty pissed? This is what a Maryland owner claims happened with her pug, Shelby.
This case also provides a good example of how the vet board believes that the vet did things he CLAIMS he did, but NEVER wrote down. SHAME on the vet boards -- for this type of behavior on their part merely encourages vets to make up any old story. Moreover, bad things happen to animals, but vet boards seem to chalk everything up to "recordkeeping" violations, which sound not-so-serious. Use your noggin, people. Read between the lines. I don't even believe the vet boards believe this shit -- but they aren't in the business of uncovering the truth, they are in the business of coddling their colleagues no matter what.
Ah, but back to the case of Shelby:
Daniel Peck owned and operated the Eastern Shore Animal Hospital in Chesterstown Maryland.
In the summer of 2003, her owner brought 1 1/2 year-old pug Shelby in to Dr. Peck because she had a lump on her left leg. Dr. Peck decided that the lump was a "histocytoma" [sic]. (Hystiocytomas are benign skin tumors usually seen in small dogs. Here are some links to more information; and by the way, these articles say that they often resolve on their own: http://vetmedicine.about.com/od/diseasesconditionsfaqs/f/FAQ_histiocytom.htm
http://www.marvistavet.com/html/body_histiocytoma.html)
But Dr. Peck recommended surgery to remove the lump, and the owner consented.
The vet board document says that Peck also performed an "ovariohysterectomy" (spay) on Shelby. Shelby's owner says that she NEVER gave permission for the spay!!!
The Board document says (emphasis added):
"Dr. Peck states otherwise, and amended the patient's record to include the following information: 'Called owner, permission given by father and Stacy.' Dr. Peck failed to initial and date this entry, signifying that it was an amendment."
OK, lemme get this straight. Shelby's owner said she never gave permission for the spay. The doctor LATER, AFTER THE FACT, modified (or "doctored?") the record to specifically say that permission was given for this spay, BUT he didn't follow state guidelines for the way to properly date and initial RETROACTIVE CHANGES MADE TO PATIENT RECORDS, indicating perhaps, that it was his intent to deceive people into believing that these were the original notations?????
The document further says:
"Dr. Peck administered an anesthetic agent to Shelby [for this surgery] (to wit: a combination of Ketamine, Rompun, Acepromizine) but failed to note in the patient's record the dosages given."
"Before anesthetizing Shelby and performing these procedures, Dr. Peck assessed the dog's physical condition, but failed to note his findings in the patient's record."
OK, so if it's not written down, HOW DO YOU KNOW HE DID IT? JUST BECAUSE HE SAYS SO??????
See how they always believe the vets? Even when the vet has NO proof, and the client has no proof, THEY TOTALLY 100 PERCENT BUY THE VET'S ACCOUNT OF THINGS!!!!!!!!
"Following surgery, Dr. Peck administered Flocillin to Shelby, but failed to note in the patient's record the amount given."
So, what did the board decide?
The board decided that Peck DID perform a physical exam of Shelby even though he wrote nothing down. BUT they found him in violation of the recordkeeping requirement.
For failing to write down the medications and amounts he used for anesthesia, they found him again in violation of record-keeping requirements. And AGAIN in violation of record keeping requirements for failing to write down that he gave Shelby Flocillin or the amount.
But the thing that really steams me is this:
For failing to initial and date his retroactive modifications to Shelby's medical records -- the one where he CLAIMS he called and got permission for the spay -- the one the owner says is total B.S. -- they just found him in violation of recordkeeping for that one too. For failing to date and initial the amendment.
They placed Peck on probation for 6 months and fined him $1,300, but they "stayed" $300 of the fine, which meant that he onnly had to pay $1,000.
As vet boards go, these are pretty high fines, but all the same, it is entirely maddening that a vet can retroactively modify his records to create documentation of things the client said NEVER occurred, and all he is found in violation of is recordkeeping. The fact that Peck did this, to me, tends to confirm the clients version of events, otherwise why would he suspiciously modify these records and not date them?
For example -- don't you think you would know whether or not you told a vet, or gave permission to a vet, to spay your dog? If you thought a vet was just going to remove a lump on your dogs leg, but your dog came out of surgery having had an entire spay performed, wouldn't you be mighty pissed? This is what a Maryland owner claims happened with her pug, Shelby.
This case also provides a good example of how the vet board believes that the vet did things he CLAIMS he did, but NEVER wrote down. SHAME on the vet boards -- for this type of behavior on their part merely encourages vets to make up any old story. Moreover, bad things happen to animals, but vet boards seem to chalk everything up to "recordkeeping" violations, which sound not-so-serious. Use your noggin, people. Read between the lines. I don't even believe the vet boards believe this shit -- but they aren't in the business of uncovering the truth, they are in the business of coddling their colleagues no matter what.
Ah, but back to the case of Shelby:
Daniel Peck owned and operated the Eastern Shore Animal Hospital in Chesterstown Maryland.
In the summer of 2003, her owner brought 1 1/2 year-old pug Shelby in to Dr. Peck because she had a lump on her left leg. Dr. Peck decided that the lump was a "histocytoma" [sic]. (Hystiocytomas are benign skin tumors usually seen in small dogs. Here are some links to more information; and by the way, these articles say that they often resolve on their own: http://vetmedicine.about.com/od/diseasesconditionsfaqs/f/FAQ_histiocytom.htm
http://www.marvistavet.com/html/body_histiocytoma.html)
But Dr. Peck recommended surgery to remove the lump, and the owner consented.
The vet board document says that Peck also performed an "ovariohysterectomy" (spay) on Shelby. Shelby's owner says that she NEVER gave permission for the spay!!!
The Board document says (emphasis added):
"Dr. Peck states otherwise, and amended the patient's record to include the following information: 'Called owner, permission given by father and Stacy.' Dr. Peck failed to initial and date this entry, signifying that it was an amendment."
OK, lemme get this straight. Shelby's owner said she never gave permission for the spay. The doctor LATER, AFTER THE FACT, modified (or "doctored?") the record to specifically say that permission was given for this spay, BUT he didn't follow state guidelines for the way to properly date and initial RETROACTIVE CHANGES MADE TO PATIENT RECORDS, indicating perhaps, that it was his intent to deceive people into believing that these were the original notations?????
The document further says:
"Dr. Peck administered an anesthetic agent to Shelby [for this surgery] (to wit: a combination of Ketamine, Rompun, Acepromizine) but failed to note in the patient's record the dosages given."
"Before anesthetizing Shelby and performing these procedures, Dr. Peck assessed the dog's physical condition, but failed to note his findings in the patient's record."
OK, so if it's not written down, HOW DO YOU KNOW HE DID IT? JUST BECAUSE HE SAYS SO??????
See how they always believe the vets? Even when the vet has NO proof, and the client has no proof, THEY TOTALLY 100 PERCENT BUY THE VET'S ACCOUNT OF THINGS!!!!!!!!
"Following surgery, Dr. Peck administered Flocillin to Shelby, but failed to note in the patient's record the amount given."
So, what did the board decide?
The board decided that Peck DID perform a physical exam of Shelby even though he wrote nothing down. BUT they found him in violation of the recordkeeping requirement.
For failing to write down the medications and amounts he used for anesthesia, they found him again in violation of record-keeping requirements. And AGAIN in violation of record keeping requirements for failing to write down that he gave Shelby Flocillin or the amount.
But the thing that really steams me is this:
For failing to initial and date his retroactive modifications to Shelby's medical records -- the one where he CLAIMS he called and got permission for the spay -- the one the owner says is total B.S. -- they just found him in violation of recordkeeping for that one too. For failing to date and initial the amendment.
They placed Peck on probation for 6 months and fined him $1,300, but they "stayed" $300 of the fine, which meant that he onnly had to pay $1,000.
As vet boards go, these are pretty high fines, but all the same, it is entirely maddening that a vet can retroactively modify his records to create documentation of things the client said NEVER occurred, and all he is found in violation of is recordkeeping. The fact that Peck did this, to me, tends to confirm the clients version of events, otherwise why would he suspiciously modify these records and not date them?
Saturday, March 15, 2008
Multiple Instances of Bad Vettery on the Part of Paul Deal in Maryland
Veterinarian Paul Deal, owner of Countryside Animal Hospital in Oakland, Maryland, is one of few veterinarians who have wracked up multiple Board disciplinary actions in just the last few years.
The three cases involve Deal's treatment of Angel the Cat; Porky, the Irish Wolfhound; and Zoey, the Labrador.
These cases also show how the Maryland Board gives the vets the benefit of the doubt when they claim they did something, but there is no proof of it in the record. Because repeatedly, when there is no record of Deal doing something he SHOULD have done for a patient, intead of finding him in violation of regulations for NOT doing that thing, they simply find him to have violated record keeping statutes -- in other words, they assume he did it but just didn't write it down. A vet could CLAIM ANYTHING, make up any fiction, and the State Board would take his word for it, but just assume that he failed to write it down. This behavior on the part of the Maryland State Board violates a fundamental precept in medical record-keeping: If it isn't written down, it didn't happen. But the Boards -- even when disciplining vets -- bend over backwards to believe their versions of events, no matter what the client and the records say. I have a little bit of personal experience with this phenomena.
The Case of Zoey the Labrador
In summer 2005, Zoey's owner brought Zoey -- a 6-year old Labrador -- in to see Dr. Deal after Zoey had reportedly jumped out of a window and broken her left front leg.
The Board document states:
"Dr. Deal examined Zoey after assuming her care, but he did not record his findings in the patient's record (excepting the notation that the dog weighed 72 pounds). In answering [the owner's] complaint against him with the Board, Dr. Deal states that, after physicially examining Zoey's left front leg, he discovered a fracture at the distal end of the radius, bu found the skin to be intact. Assuming this statment is true, Dr. Deal failed to record this and other pertinent information in the patient's record including, but not limited to, the dog's temperature and pulse."
"Dr. Deal did not radiograph Zoey's front leg that night. He did administer morphine to the dog, and then confined her in a cage for the night."
[OK, do you not find this ridiculous? How can you properly and thoroughly characterize a break if you do not take x-rays? Why did he not take x-rays until the following day?]
"On or about the following day, Dr. Deal radiographed Zoey's leg, entering the following notation in the patient's record: 'X-ray radius/ulna - fx [fractured] distal radius and ulna with overriding.' Dr. Deal, however, did not describe the fracture to [Zoey's owner] after radiographing Zoey's leg. Likewise, Dr. Deal did not obtain [Zoey's owner's] consent before proceeding with his plan to manage the dog's fractured leg, that being: performing a closed reduction and external coaptation."
Um, yeah, I had to look that up -- it's surgery. He didn't talk to the owner to get her consent to do this surgery, she probably didn't even know he was doing it.
The Board continues:
"Dr. Deal examined Zoey before anesthetizing the dog and performing the surgery upon her, but he did not record his findings in the patient record."
Um, if he didn't record anything in the record, how do they know he adequately examined her before anesthetizing her???? Just because he SAYS SO, right? This is a good example of how the Board believes what the vet says in the absence of evidence, knowing very well the vet could be lying, and I am certain that in general, the vets often do lie and SAY they did thing they know they should have done, but did not do, or vice versa. The deck is stacked against pet owners because these boards -- vets themselves -- just believe whatever unsubstantiated crap flows out of these vets mouths.
"Likewise, following surgery, Dr. Deal did not record in the patient's record the progress and disposition of the case."
Hey, BOZO board. Maybe the reason he didn't record anything is because he wasn't even monitoring the dog, ever occur to you?
"On or about the same day, Dr. Deal dischared Zoey to [her owner's] care. If Dr. Deal instructed [Zoey's owner] on how to care and manage Zoey until such time that the dog could be seen by her regular veterinarian, Dr. Deal did not record this event in the patient's record."
So, after all that, what did the Board find that Dr. Deal did wrong?
RECORDKEEPING VIOLATIONS. Penalty = $500 and a STAYED suspension (which is a meaningless paper suspension -- not 1 day of work missed). They also gave him 6 months probation, but the only conditions of probation are not to violate regulations, which is a silly condition since it is a condition that always applies to all vets all the time, there is no punitive element to it.
The Case of Porky the Irish Wolfhound
In spring of 2004 Porky's owner brought Porky, a 4-year old Irish Wolfhound, in to Dr. Deal because Porky was having seizures.
The Board document says:
"In answering [Porky's owner's] complaint against him with the Board, Dr. Deal provided a short history of Porky's condition as it pertained to the dog's medical status; that being: Porky had been previously treated for seizures by a veterinarian in Ohio, but was no longer receiving this treatment (if [the owner] informed Dr. Deal of the particular treatment that the Ohio veterinarian had prescribed (e.g., the amount and frequency of any medication provided), Dr. Deal did not note it). Dr. Deal also provided his initial diagnosis of Porky's condition; that being: Status epilepticus."
"In the record . . Dr. Deal did not provide the aforementioned short history of Porky's condition as it pertained to his medical status. Likewise he did not provide his initial diagnosis."
"Assuming Dr. Deal thoroughly examined Porky (phsyically and neurologically) when the dog was first presented, excepting his weight and that the dog was having trouble breathing, he did not record his findings in the patient's record, including, but not limited to, the dog's temperature (the failure to record and monitor Porky's temperature is particularly problematic because increased temperatures commonly occur in dogs with status epilepticus.)"
". . . Dr. Deal administered diazepam [valium] intravenously to the dog, and made the following comment in the patient's record: "achieved desired effect" - suggesting that the medication had terminated Porky's seizure activity. Dr. Deal, howeer, provided no details in the patient's record documenting that this had actually occurred." [Then how in the world do we know that it did occur?] "That same day Dr. Deal also provided a two week supply of Phenobarbital at a dosage of 64 mg BID (less than the recommended dosage of 2-8 mg/kg BID.) If this dosage was the maintenance dosage that the Ohio veterinarian had prescribed to treat Porky's seizure problem, Dr. Deal did not note this in the record." [Why would they assume that when it is the wrong dose -- an inadequate amount? Porky weighed 100 pounds. That is 45.36 kilograms. If the Board's statement that the recommended dose of this drug is 2-8 mg/kg, then Porky's dose should have been a minimum of 90 mg, up to 362 mg.]
"On Monday, June 14 . . . Porky paid a return visit to Dr. Deal. In the patient's record for this date, Dr. Deal noted that Porky reportedly had repetitive seizures over the weekend. Another entry suggested that Dr. Deal may have examined Porky that day. Assuming this examination occurred, however, Dr. Deal did not record his observations in the patient's record." [Then how do they know it occurred? Becase he says so?]
"Dr. Deal did renew the Phenobarbital prescription that day, but failed to specify in the patient's record how much medication was dispensed, and thus, how long the medication should continue."
" . . . Dr. Deal made no entries in the patient record stating how the dog's seizure disorder was responding to the prescribed treatment."
What did the Board find him on?
RECORDKEEPING.
The Case of Angel the Cat.
Angel was a 5-year old cat. Angel's owner brought her into Dr. Deal's hospital because he had a urethral obstruction.
The Board document says:
"If Dr. Deal examined Angel that day, after assuming the cat's care, he did not record his findings in the patient's record (excepting the notation that the cat weighed 10 pounds)."
"After removing the obstruction, Dr. Deal expressed the cat's bladder completely. Dr. Deal made the following notations in the patient's record concerning the cat's post-surgical condition: "urine very bloody," "severe cyanosis developed after the bladder expressed," [cyanosis is when you turn blue from lack of oxygen!], "responded to intubation and room air resuscitation," "tomcat catheter intalled and left overnight," "Metacam overnight for pain." Dr. Deal did not record the dosage of Metacam that Angel received."
OK -- here is a big thing. Metacam is an NSAID -- non-steroidal anti-inflammatory drug. This drug should be used with GREAT CAUTION in cats if at all. The veterinary information network says "the wrong dose of meloxicam [Metacam] can be very dangerous for cats"; it also says:
"It is also important that NSAIDS not be given to dehydrated patients because of this potential side effect [of reducing blood flow to the kidneys]. This is particularly true in cats."
I mention this because the board document notes that Dr. Deal "did not administer fluid therapy to Angel"; this combined with the Metacam is very concerning for a variety of reasons. The Board document says:
"failure to administer subcutaneous fluid to an obstructed cat to correct subclinical dehydration, meet maintenance fluid requirements, and keep up with losses from potential post-obstructive diuresis, constitutes substandard care."
"On the following day, Dr. Deal discharged Angel to [her owner] . . . " On or about June 23, 2005, Angel was returned to Dr. Deal. "Dr. Deal's notations in the patient's record concerning this visit consist of the following remarks: "SICK" [no duh -- did you go to vet school to be able to render such brilliant diagnoses?]; "bladder is not emptying properly but no plugged - expressed bladder with no resistance," "healthy appearance to urine - owner insisted on taking patient home against advice," "recheck tomorrow.' If Dr. Deal physically examined Angel on that date, he did not record his findings in the patient's record."
OK dear reader, am I the only one who suspects a little retroactive notations in the record here?
This guy didn't write anything down in the records -- doesn't record the patient's vitals, doesn't record things hardly at all anyway as the Board says, but somehow, he produces a record that says "owner insisted on taking patient home against advice" once a complaint has been filed against him? Do you smell some CYA going on?
This record doesn't tell you what happend to Angel, but I am betting that he died. Being giving potentially kidney toxic metacam while being given no fluid support as sick as he was -- that doesn't bode well.
The Board found Deal yet again in violation of a slew of recordkeeping counts, and one instance of substandard care for failure to give Angel fluids.
For these two cases (Porky and Angel) Deal was fined $1,700 and got a stayed suspension for 2 weeks -- again, meaningless; it is a paper-only suspension and the vet loses not ONE minute of work; and he was placed on probation for 6 months, but that too is meaningless, since the only condition of probation is that he pay the fine he already has to pay and that he not break any regulations -- which apply to all vets at all times - so HOW is that a condition of probation?
"Don't break the laws you shouldn't have broken in the first place?"
Another Bad Sign about Deal and his practice: The entire practice apparently -- according to the website -- consists of him, his wife, and his daughter. Bad sign. Exactly what kind of objective third party testimony do you think is every going to be given by other people at that practice? Do you think they cover for each other?
The three cases involve Deal's treatment of Angel the Cat; Porky, the Irish Wolfhound; and Zoey, the Labrador.
These cases also show how the Maryland Board gives the vets the benefit of the doubt when they claim they did something, but there is no proof of it in the record. Because repeatedly, when there is no record of Deal doing something he SHOULD have done for a patient, intead of finding him in violation of regulations for NOT doing that thing, they simply find him to have violated record keeping statutes -- in other words, they assume he did it but just didn't write it down. A vet could CLAIM ANYTHING, make up any fiction, and the State Board would take his word for it, but just assume that he failed to write it down. This behavior on the part of the Maryland State Board violates a fundamental precept in medical record-keeping: If it isn't written down, it didn't happen. But the Boards -- even when disciplining vets -- bend over backwards to believe their versions of events, no matter what the client and the records say. I have a little bit of personal experience with this phenomena.
The Case of Zoey the Labrador
In summer 2005, Zoey's owner brought Zoey -- a 6-year old Labrador -- in to see Dr. Deal after Zoey had reportedly jumped out of a window and broken her left front leg.
The Board document states:
"Dr. Deal examined Zoey after assuming her care, but he did not record his findings in the patient's record (excepting the notation that the dog weighed 72 pounds). In answering [the owner's] complaint against him with the Board, Dr. Deal states that, after physicially examining Zoey's left front leg, he discovered a fracture at the distal end of the radius, bu found the skin to be intact. Assuming this statment is true, Dr. Deal failed to record this and other pertinent information in the patient's record including, but not limited to, the dog's temperature and pulse."
"Dr. Deal did not radiograph Zoey's front leg that night. He did administer morphine to the dog, and then confined her in a cage for the night."
[OK, do you not find this ridiculous? How can you properly and thoroughly characterize a break if you do not take x-rays? Why did he not take x-rays until the following day?]
"On or about the following day, Dr. Deal radiographed Zoey's leg, entering the following notation in the patient's record: 'X-ray radius/ulna - fx [fractured] distal radius and ulna with overriding.' Dr. Deal, however, did not describe the fracture to [Zoey's owner] after radiographing Zoey's leg. Likewise, Dr. Deal did not obtain [Zoey's owner's] consent before proceeding with his plan to manage the dog's fractured leg, that being: performing a closed reduction and external coaptation."
Um, yeah, I had to look that up -- it's surgery. He didn't talk to the owner to get her consent to do this surgery, she probably didn't even know he was doing it.
The Board continues:
"Dr. Deal examined Zoey before anesthetizing the dog and performing the surgery upon her, but he did not record his findings in the patient record."
Um, if he didn't record anything in the record, how do they know he adequately examined her before anesthetizing her???? Just because he SAYS SO, right? This is a good example of how the Board believes what the vet says in the absence of evidence, knowing very well the vet could be lying, and I am certain that in general, the vets often do lie and SAY they did thing they know they should have done, but did not do, or vice versa. The deck is stacked against pet owners because these boards -- vets themselves -- just believe whatever unsubstantiated crap flows out of these vets mouths.
"Likewise, following surgery, Dr. Deal did not record in the patient's record the progress and disposition of the case."
Hey, BOZO board. Maybe the reason he didn't record anything is because he wasn't even monitoring the dog, ever occur to you?
"On or about the same day, Dr. Deal dischared Zoey to [her owner's] care. If Dr. Deal instructed [Zoey's owner] on how to care and manage Zoey until such time that the dog could be seen by her regular veterinarian, Dr. Deal did not record this event in the patient's record."
So, after all that, what did the Board find that Dr. Deal did wrong?
RECORDKEEPING VIOLATIONS. Penalty = $500 and a STAYED suspension (which is a meaningless paper suspension -- not 1 day of work missed). They also gave him 6 months probation, but the only conditions of probation are not to violate regulations, which is a silly condition since it is a condition that always applies to all vets all the time, there is no punitive element to it.
The Case of Porky the Irish Wolfhound
In spring of 2004 Porky's owner brought Porky, a 4-year old Irish Wolfhound, in to Dr. Deal because Porky was having seizures.
The Board document says:
"In answering [Porky's owner's] complaint against him with the Board, Dr. Deal provided a short history of Porky's condition as it pertained to the dog's medical status; that being: Porky had been previously treated for seizures by a veterinarian in Ohio, but was no longer receiving this treatment (if [the owner] informed Dr. Deal of the particular treatment that the Ohio veterinarian had prescribed (e.g., the amount and frequency of any medication provided), Dr. Deal did not note it). Dr. Deal also provided his initial diagnosis of Porky's condition; that being: Status epilepticus."
"In the record . . Dr. Deal did not provide the aforementioned short history of Porky's condition as it pertained to his medical status. Likewise he did not provide his initial diagnosis."
"Assuming Dr. Deal thoroughly examined Porky (phsyically and neurologically) when the dog was first presented, excepting his weight and that the dog was having trouble breathing, he did not record his findings in the patient's record, including, but not limited to, the dog's temperature (the failure to record and monitor Porky's temperature is particularly problematic because increased temperatures commonly occur in dogs with status epilepticus.)"
". . . Dr. Deal administered diazepam [valium] intravenously to the dog, and made the following comment in the patient's record: "achieved desired effect" - suggesting that the medication had terminated Porky's seizure activity. Dr. Deal, howeer, provided no details in the patient's record documenting that this had actually occurred." [Then how in the world do we know that it did occur?] "That same day Dr. Deal also provided a two week supply of Phenobarbital at a dosage of 64 mg BID (less than the recommended dosage of 2-8 mg/kg BID.) If this dosage was the maintenance dosage that the Ohio veterinarian had prescribed to treat Porky's seizure problem, Dr. Deal did not note this in the record." [Why would they assume that when it is the wrong dose -- an inadequate amount? Porky weighed 100 pounds. That is 45.36 kilograms. If the Board's statement that the recommended dose of this drug is 2-8 mg/kg, then Porky's dose should have been a minimum of 90 mg, up to 362 mg.]
"On Monday, June 14 . . . Porky paid a return visit to Dr. Deal. In the patient's record for this date, Dr. Deal noted that Porky reportedly had repetitive seizures over the weekend. Another entry suggested that Dr. Deal may have examined Porky that day. Assuming this examination occurred, however, Dr. Deal did not record his observations in the patient's record." [Then how do they know it occurred? Becase he says so?]
"Dr. Deal did renew the Phenobarbital prescription that day, but failed to specify in the patient's record how much medication was dispensed, and thus, how long the medication should continue."
" . . . Dr. Deal made no entries in the patient record stating how the dog's seizure disorder was responding to the prescribed treatment."
What did the Board find him on?
RECORDKEEPING.
The Case of Angel the Cat.
Angel was a 5-year old cat. Angel's owner brought her into Dr. Deal's hospital because he had a urethral obstruction.
The Board document says:
"If Dr. Deal examined Angel that day, after assuming the cat's care, he did not record his findings in the patient's record (excepting the notation that the cat weighed 10 pounds)."
"After removing the obstruction, Dr. Deal expressed the cat's bladder completely. Dr. Deal made the following notations in the patient's record concerning the cat's post-surgical condition: "urine very bloody," "severe cyanosis developed after the bladder expressed," [cyanosis is when you turn blue from lack of oxygen!], "responded to intubation and room air resuscitation," "tomcat catheter intalled and left overnight," "Metacam overnight for pain." Dr. Deal did not record the dosage of Metacam that Angel received."
OK -- here is a big thing. Metacam is an NSAID -- non-steroidal anti-inflammatory drug. This drug should be used with GREAT CAUTION in cats if at all. The veterinary information network says "the wrong dose of meloxicam [Metacam] can be very dangerous for cats"; it also says:
"It is also important that NSAIDS not be given to dehydrated patients because of this potential side effect [of reducing blood flow to the kidneys]. This is particularly true in cats."
I mention this because the board document notes that Dr. Deal "did not administer fluid therapy to Angel"; this combined with the Metacam is very concerning for a variety of reasons. The Board document says:
"failure to administer subcutaneous fluid to an obstructed cat to correct subclinical dehydration, meet maintenance fluid requirements, and keep up with losses from potential post-obstructive diuresis, constitutes substandard care."
"On the following day, Dr. Deal discharged Angel to [her owner] . . . " On or about June 23, 2005, Angel was returned to Dr. Deal. "Dr. Deal's notations in the patient's record concerning this visit consist of the following remarks: "SICK" [no duh -- did you go to vet school to be able to render such brilliant diagnoses?]; "bladder is not emptying properly but no plugged - expressed bladder with no resistance," "healthy appearance to urine - owner insisted on taking patient home against advice," "recheck tomorrow.' If Dr. Deal physically examined Angel on that date, he did not record his findings in the patient's record."
OK dear reader, am I the only one who suspects a little retroactive notations in the record here?
This guy didn't write anything down in the records -- doesn't record the patient's vitals, doesn't record things hardly at all anyway as the Board says, but somehow, he produces a record that says "owner insisted on taking patient home against advice" once a complaint has been filed against him? Do you smell some CYA going on?
This record doesn't tell you what happend to Angel, but I am betting that he died. Being giving potentially kidney toxic metacam while being given no fluid support as sick as he was -- that doesn't bode well.
The Board found Deal yet again in violation of a slew of recordkeeping counts, and one instance of substandard care for failure to give Angel fluids.
For these two cases (Porky and Angel) Deal was fined $1,700 and got a stayed suspension for 2 weeks -- again, meaningless; it is a paper-only suspension and the vet loses not ONE minute of work; and he was placed on probation for 6 months, but that too is meaningless, since the only condition of probation is that he pay the fine he already has to pay and that he not break any regulations -- which apply to all vets at all times - so HOW is that a condition of probation?
"Don't break the laws you shouldn't have broken in the first place?"
Another Bad Sign about Deal and his practice: The entire practice apparently -- according to the website -- consists of him, his wife, and his daughter. Bad sign. Exactly what kind of objective third party testimony do you think is every going to be given by other people at that practice? Do you think they cover for each other?
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