What Happened to "Patch Parker" as a Result of South Carolina Vet Frank Hooper's Substandard "Care?"

The South Carolina Veterinary Board has demonstrated that, although it has a mission to "protect citizens by ensuring that only qualified and competent veterinary practitioners operate in South Carolina," like other vet boards, it doesn't seem particularly eager to publicize the details that gave rise to its disciplinary actions.

As a rule, South Carolina's "Consent Agreements" are lacking in adequate detail for a consumer to really figure out what happened. Why is this a problem?

This is a problem because, as a consumer, it is vitally important for us to know what the veterinarian did, so that we can evaluate and assess his or her behavior. This kind of information is critical for making informed choices about veterinary care.

So, it is a good thing that recently, the South Carolina Vet Board began making the "Formal Complaints" available on its website. The Formal Complaint is the document filed by the Veterinary Board charging the vet with violations, and it typically includes more detail than the final "Consent Agreement."

Nonetheless, the IMPACT on the patient of the vet's behavior is often omitted from both documents. Perhaps this is because vet boards do not want to state that the vets behavior actually caused the death or injury of the animal. And maybe they don't want to say so because they can't be sure that's true. On the other hand, maybe they don't want to say so because it would indicate to the consumer exactly how dangerous this vet may be. Goodness knows, we wouldn't want to give the consumer information that would steer him away from a vet, would we? Even if that vet had behaved dangerously. Oh, but there is that little problem of the mission statement . . .

Both the Consent Agreement and the Formal Complaint filed by the Board in the case of Frank Hooper and his treatment of Patch Parker are lacking one important fact, and leave the reader asking: "WHAT HAPPENED TO 'PATCH'?"

Well, I think we can make an educated guess. Here are the facts that we do know . . .

In the Formal Complaint, the Veterinary Board asserted that in January 2007 " . . . an American Pit Bull named 'Patch' was presented to Guingnard Veterinary Clinic incident to a severe limp. Patch could not place weight o his front right legl. Patch was examined by another veterinarian. The owner reports that the other veterinarian opined that the leg was fractured and required surgery. The owner provided consent to repair the fracture."

Two days later, vet Frank Hooper operated on Patch. The Board says that Hooper's "records do not document the completion of a physical examination of Patch before commencing surgery. [Hooper] did not notify Patch's owner that Patch's surgery would be more extensive than originally assumed by the other veterinarian."

[OK, what's that supposed to mean? Please tell me -- if you DO NOT conduct a physical exam of a patient prior to cutting into him, how the heck do you know you need to, uh, expand the surgery and make it more extensive?]

Hooper, the document says, did not contact the owners before surgery.

Then, the document says, "The surgical procedure was extended due to the unavailability of certain equipment, a personnel shortage, and the complexity of the procedure."

[Um, what? Did he not CHECK to make sure he had all the needed equipment and staff before starting????? So, basically, this dog was under anesthesia longer . . . ?????

Hooper, it says, ". . . interrupted the surgical process while the animal remained under anesthesia. [Hooper] permitted his technician to depart from the area without ensuring that someone monitored the animal. [Hooper] failed to ensure that the oxygen supplies for Patch's surgery were adequate and to ensure the availability of equipment that was necessary for Patch's surgery."

"A review of [Hooper's] records relating to this mattre reveal that a physical examination was not conducted prior to the procedure. [Hooper] failed to rcord the route of administation of Telazol, a controlled substance. [Hooper] did not record the dose and administration of Atropine."

The document goes on to cite the violations the Board charged Hooper with, which include failure to "provide or maintain proper facilities, engag[ing] in unprofessional or unethical conduct, and engag[ing] in incompetent or negligent conduct" as well as failure to provide proper supervision of the technician and failure to keep proper records for Patch's treatment and drug administration.

What the document does NOT say is what happened to Patch.

What do you think?

Is it your guess -- as it is mine -- that the dog probably DIED? After all, we have:

• Failure to examine the dog prior to surgery


• Expanding the surgery to make it more "extensive" without ever having examined the dog


• Prolonged surgery in which the patient was apparently left under anesthesia while people left the area


• Reference to inadequate oxygen supplies and inadequate equipment, as well as failure to record how much anesthetic drugs they gave Patch and how they were administered

Do you think -- without saying what happened to Patch -- consumer's will realize that this kind of behavior COULD LEAD to the death of a patient, whether or not it did?

LINKS:

Board Consent Agreement with Frank A. Hooper

"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.

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

Bad Vet Robert Feher of Brewer Animal Clinic in Brewer Maine: Disciplined 3 Times by Board

The website of Brewer Veterinary Clinic says that veterinarian Robert Feher has a "special emphasis on surgery – specializing in Orthopedics and intricate, detailed surgeries." Oh yeah? Let's take a look at Feher's record, and then you decide: Do you want his surgical "special" treatment for your pet?

Feher has a long record with the Maine Veterinary Board. If you know anything about Veterinary Boards, you know that they pretty much are loathe to discipline a vet, and rarely discipline a vet once, much less three times. What does it take to incite a vet board to actually discipline a vet three times? How bad does it have to be?

In 2000, the Maine Veterinary Board found that Feher had committed "GROSS NEGLIGENCE" in his treatment of a golden retriever in his care.

In 2002, the Maine Veterinary Board found Feher's behavior constituted "incompetence in the surgical repair of the fractured femur."

And in 2006, the Board found that he "failed to share the results of the subject dog's abnormal pre-operative blood work with the dog's owner prior to performing surgery on the subject dog, and that he failed to perform appropriate pre-operative blood work or urinalysis prior to the subject dog's second surgery." (I do NOT have a good feeling about what probably happened to that dog . . . )

Is this what you want for your pet? Gross negligence? Incompetent surgeries? Cutting into your pet repeatedly, on more than one occasion, and failing to discuss your pet's abnormal bloodwork with you before hand (pre-existing conditions that show up in bloodwork can indicate increased surgical risks) or failing to do pre-opeartive bloodwork or urine at all???????

This is the guy that wants to do "intricate, detailed surgeries" on your pet.

I'm thinking that's an offer you want to DECLINE.

In 2007, the State of Iowa's veterinary board also disciplined Feher. Feher, who went to vet school in Iowa, is also licensed in that state, and Iowa fined him $500 for failing to report to them the disciplinary action taken against him by Maine (which he is required to do).

Here are the excerpts from the Board documents, available online:

FEHER, Robert C.
License Number: VT503
License Type: Veterinarian
Case Number: VET-113
Disposition: Consent Agreement dated 7/13/00
Summary: Licensee admitted to gross negligence in his treatment of a client's golden retriever by failing to take x-rays and failing to treat the dog as aggressively as circumstances required. Licensee was issued a $1250 civil penalty and was ordered to pay $250 for investigative costs incurred by the board.

FEHER, ROBERT C.
License Number: VT503
License Type: Veterinarian
Case Number: VET-155
Disposition: Consent Agreement dated 12/2/02
Summary: Licensee admitted that a surgical procedure on a puppy failed to meet the standard of care, and that such conduct amounts to incompetence in the surgical repair of the fractured femur. Licensee agreed to a censure and a $500 civil penalty. Licensee also agreed to obtain 12 hours of continuing professional education in orthopedics.


FEHER, ROBERT C.
License Number: VT503
License Type: Veterinarian
Complaint Number: 2005-VET-2049
Disposition: Consent Agreement dated 8/1/06
Summary: Licensee admitted that he failed to share the results of the subject dog's abnormal pre-operative blood work with the dog's owner prior to performing surgery on the subject dog, and that he failed to perform appropriate pre-operative blood work or urinalysis prior to the subject dog's second surgery. Licensee agreed to a censure and also agreed to obtain eight hours of continuing professional education in the field of internal medicine.

Links:

See Maine Disciplinary Records here