Re: *** and my assessment of veterinary medical practice below standard of care and negligence, as well as failure to maintain appropriate medical records.
To whom it may concern:
The following is my assessment of the sequence of clinical events, surrounding the tragic passing of ***, a previously deceased, 7-year-old, approximately 17-pound, male Dachshund, belonging to ***, and who passed from complications from gastrointestinal ulceration and perforation, which resulted in peritonitis, sepsis, and acute kidney failure. It is my STRONG professional opinion, based on 30 years of clinical veterinary experience, that *** was the victim of gross negligence and malpractice, involving inappropriate use of corticosteroids and non-steroidal anti-inflammatory drugs at the same time, as well as negligent medical practice at multiple points of treatment, leading up to the gastrointestinal perforation. There were also totally inadequate medical records on this case at several stages of treatment as well by the primary veterinary care hospital at ***.
In reviewing the quite minimal medical records supplied to me in this case, the evidence of negligent medical practices is obvious as early as June 18, 2019, when *** was treated with both a dexamethasone injection and Rimadyl injection for some sort of acute medical condition (no physical exam or SOAP notes provided by Veterinary Clinic). There is no justifiable and reasonable medical reason why any canine patient should receive treatment with both a strong corticosteroid such as Dexamethasone, and a non-steroidal drug like Rimadyl at the same time, especially with ***’s medical history. On this date, she was also sent home with generic Rimadyl (known as Vetprofen) tablets. I have no idea what *** was being treated for on June 18, 2019, as did not supply any medical records for this date. The concomitant use of both a corticosteroid and non-steroidal anti-inflammatory drug pose severe medical risks to the patient, including gastrointestinal erosion and ulceration, as well as significant immune suppression in any aged patient, even when used short term. This is even more inexcusable with ***’s medical history, as *** was suffering from a chronic autoimmune disease of her colon for 2.5 years, which had been diagnosed in 2017 at by endoscopic biopsy. According to ***, *** had been misdiagnosed and wrongly prescribed medications for “supposed pancreatitis” by at that time in 2017, with a 3-month history of severe, mucousy and bloody stools, which was not responding to treatment for pancreatitis. It was not until the correct diagnosis was made by *** and the appropriate, oral prednisone prescribed, that *** experienced clinical relief of this chronic and incurable autoimmune bowel condition. In fact, at the time of ***’s passing, she had still been on a low maintenance dose of prednisone to control this chronic bowel condition, and so the prescribing of Vetprofen on June 18, 2019, was an early sign of medical negligence and malpractice, given that *** was taking oral prednisone long term.
The next date of medical malpractice in this case is obvious on September 23, 2019. On this date, *** received both a 6 in one vaccination (containing Distemper / Adenovirus / Parainfluenza / Parvovirus / Leptospirosis and Coronavirus), IN ADDITION to her Rabies vaccination on this date. Current standards of practice at all veterinary schools in the country, including ***, recommend not more than once every three years for core viral vaccinations, including Distemper/Parvo combination vaccinations and Rabies. These are recommendations made by immunological experts in veterinary medicine, due to documented long term immunity to these core viral vaccinations, as well as the risks of severe autoimmune or immunosuppressive disease from vaccinating for these core viruses too frequently. It should also be noted that it had only been 10.5 MONTHS since ***’s previous DAPP vaccination, which had been given on November 3, 2018. I should also note that well respected veterinary medicine vaccine experts, such as W. Jean Dodds, DVM, caution that certain small breeds, such as the Dachshund are even more susceptible to immune reactions from over-vaccination. It also says in all vaccine inserts that the vaccinations are to be given to healthy animals only. *** was suffering from a chronic autoimmune bowel condition, and should never have been vaccinated like this, much less only 10 months apart. It is also recommended that in breeds like Dachshunds multiple vaccinations like this not be given on the same day, as it was in this case. I should also note that including the non-core vaccination Leptospirosis in the combination also should have involved a discussion with as to whether this vaccination was appropriate for *** given her lifestyle, as this vaccination is considered by many to be one of the most immunogenic and reactive of the potential vaccinations given to dogs.
The date of these combination vaccinations is important in this case, as only one month late on October 26, 2019, *** re-presented to, for what called a “knot on her back”, which looked like she may have been bitten by something, yet no altercation with another animal or insect bite was directly observed. In the minimal record provided, the only history recorded said, “checking a spot on the back,” at a location where typically one or both vaccinations may have been given a few weeks earlier. As there were no exam notes from the September 23, 2019, exam, we have no idea where the vaccinations were given. Vaccination lump reactions are common in the days and weeks ahead, especially when polyvalent, multiple vaccinations are given at the same time, and especially in the Dachshund breed. There are no physical exams or SOAP notes provided by on this date either on October 26, 2019. There is a receipt for services provided to me, as well as the listing of “Staff Name” at the top of the receipt, which lists the name of, whom I am not sure is a licensed veterinarian, veterinary technician, or other staff member of. On this date, *** was given a Dexamethasone injection and PCN (antibiotic) injection, while being sent home on Amoxicillin at dose of 100 mg twice daily and a topical solution to apply to the spot on her back.
The next service provided by was on November 6, 2019, where it only says “Recheck” in the minimal records provided to me, as well as a “Staff Name” of ***, whom I do not know either, if she is a licensed veterinarian or veterinary nurse/technician. According to there was little change since October 26, 2019, and therefore surgery was scheduled for November 7, 2019, where according to the minimal record provided, it says “Clean/Flush” with listed under “Staff Name” on that date, however it is not clear whether she is the veterinarian that day or not. On that same day, however an “owner release” is signed, where consents and authorizes, DVM to “prescribe for, treat or operate upon” ***. On the receipt that day is listed “tumor removal”, which I can only assume was the mass or lump from a “likely” vaccine reaction, however no surgical notes were provided, or biopsy performed for definitive diagnosis. This also differs from what the medical notes said earlier and later on, where a “brown recluse spider bite” was noted in the record, which certainly is not the same as a tumor? I am confused on who performed the surgery that day, whether did the procedure or, who was legally given consent to operate on ***. I should also note that did not offer pre-surgical blood work, which should have been routine, minimum standard of care diagnostics offered on a 7-year-old Dachshund with ***’s medical history, as well as to see if there were any underlying metabolic causes that *** may have had, and which could have been a cause of delayed wound healing. On the receipt that day on November 7, 2019, there is no anesthetic listed that was used to “remove the tumor,” which is very problematic, both from a medical record keeping perspective, as well as understanding if any anesthetic was used at all? Once again (as done on June 18, 2019, for an unknown condition) *** was given a Dexamethasone injection, Rimadyl injection, as well as the same Penicillin injection (i.e., PCN) that had not worked the first time on October 26, 2019. Once again *** is sent home on generic Rimadyl (i.e Vetprofen) at a dose of 37.5 mg once daily, even though *** is already on maintenance prednisone for her chronic colitis. It is also highly disturbing that NO further antibiotics were dispensed on the surgical date, even though the lesion was getting progressively worse, with no definitive diagnosis, wound culture (which should have been done) or biopsy performed.
According to ***, he heard loud crying coming from ***’s operating room, after which a veterinary employee emerged saying that he could not take *** home, unless he signed a waiver, which was provided to me for review, in preparation for writing this letter. This “Acknowledgement and Waiver Against Medical Advice” lists that *** had elected to take *** home “under anesthetic without proper medical observation.” However, there is nothing listed in the scant records about which, IF ANY anesthetic was used for the “Tumor removal,” or ANY discussion between and the staff at that *** should stay in the clinic longer for her recovery from surgery. The only other record notation from was the following day on November 8, 2019, where it simply lists “Rebandage,” along with the “Staff Name” of listed, who is also not listed as a veterinary technician or doctor, nor are there any notes about the condition of the wound or bandage changing process. According to, after he got *** home from surgery the bandage was falling off with the post op wound full of blood, at which point he had to place the bandage back on himself. He returned to on November 8, 2019, however, never saw the “supposed” veterinary surgeon ***, DVM to discuss his concerns and fears, as *** was taken into the back, where her bandage was changed, and he was told to return in 3 days after the weekend for a next recheck. *** progressively declined over the weekend from November 8 through November 10 with development of severe lethargy, vomiting, poor appetite, and no thirst, while not producing any urine or stool.
Because *** was rapidly failing, took *** to *** at 4:53 PM on November 10, 2019. Evaluation at the ER showed at the distal end of the suture line, that there was evidence of skin necrosis (i.e., dying, black tissue), as well as rapidly developing cellulitis, with serosanguinous discharge located at the surgical site on the left lateral thorax. Initial assessment and blood work showed upper GI bleeding, melena (digested blood in the stool), acute kidney failure, with creatinine of 9.7 (reference range .5 to 1.3), BUN <140 (reference range 10-26), Potassium 7.1 (reference range 3.4-4.9), as well as severe metabolic acidosis with TCO2 of 13 (reference range 17-25). *** also was clearly septic with white blood cell count of over 65,000 (reference range 5000-16000) and significant left shift with bands present. Urine analysis confirmed acute kidney failure damage with ph of 5.0, plus 300 glucoses in the urine, and a urine specific gravity of 1.010. *** was subsequently admitted for intensive ICU level treatment for gastrointestinal bleeding and acute renal failure. On the following day of admission on November 11, 2019, of the Internal Medicine Service was consulted for an abdominal ultrasound, which confirmed a significant peritonitis with a large amount of peritoneal effusion in the abdominal cavity, along with a “corrugated duodenum” on the ultrasound, which he concluded was due to a high GI perforation. *** states in the medical record that “I have a very high index of suspicion for a high GI perforation, given ***’s clinical presentation and HISTORY OF RECEIVING BOTH STEROIDS AND NSAIDS.” *** spent several days at *** until November 14, 2019, where she was discharged on several medications and almost a $4,000 total bill. Unfortunately, over the next several days, *** did very poorly at home, and was subsequently euthanized on November 19, 2019, due to excessive suffering, poor quality of life and extremely poor prognosis of recovery.
In my 30 years of veterinary medical practice, I have never seen a case so mismanaged on so many levels from the outset of this case that I have documented in chronological order in this letter. The areas of negligence, malpractice, as well as practicing below ANY expected minimal standard of care are evident here, in addition to the atrocious and totally unacceptable medical record keeping in this case. In fact, there is only one date in ***’s 2019 medical history provided on February 25, 2019, where there are acceptable SOAP medical notes for *** on that date. However, NO exam or SOAP notes were provided for the dates needed in this case from October 26, 2019, through November 8, 2019, when *** was under ***’s primary care for the bite or tumor.
Following my initial phone discussion with *** on April 8, 2020, I asked him to contact and obtain the appropriate medical records on the relevant dates from October 26, 2019, through November 8, 2019. *** contacted multiple times on April 9, 2020, to obtain the medical records on these dates, at which point an employee named “***” sent a scant email of minimal records. At 1:42 PM on April 9, 2020, spoke to, (who is supposedly wife) spoke to ***, who told that there are usually exam notes, but for some reason they were not put into the computer, and therefore had no additional medical records to provide. According to he was told that there were no exam notes from October 26, 2019 (date of ***’s first presentation for the supposed bite) or from November 7, 2019 (date of the “Tumor Removal” surgery) or November 8, 2019 (one day post op rechecks). According to ***, he informed me that he was told that usually makes SOAP exam notes, but they don’t have them in this case, and did not know why, nor could they provide more information than they already had.
In my strong opinion for the multiple reasons cited throughout this letter, Mr. ***, who should receive significant damages, including the entire veterinary expenses of almost $6,000 post operatively from the date of the surgery on November 7, 2019. I also feel that there was undue emotional damage incurred both with himself, as well as for ***, who was the ultimate victim of negligence, malpractice, and in my opinion, animal abuse. Please let me know if you have any other questions.