Requesting reimbursement for the misdiagnosis and initial wrong course of treatment of our dog while boarded 18-27 July 2014.
Our dog was dropped off for boarding 18 July 2014, in normal health. On July 24, Flint River Bed N Biscuit calls and states that our dog cannot use its rear legs. After hip radiographs were taken, Dr. ***** **** treated our dog for an enlarged bladder with SMZ/TMP. We never received another call and returned from our vacation July 27.
At boarding pickup July 27, our dog had no use of his rear legs and had to be towel walked out. Boarding provided no explanation as to whether his condition had improved or worsened. We demanded Dr. **** call first thing Monday morning, July 28.
At home, we immediately researched what could cause such sudden ataxia. Tick-borne infection was the top result. After we (the patients) suggested to Dr. **** that a neurological infection must be causing the ataxia, he prescribed Minocycline July 28 and sent the July 24 blood off for additional tests (which Dr. **** even excluded the eventual neurological infection from this test order). Not until we visited with an AVSS Orthopedic specialist and a regionally renowned veterinarian, did we finally get the correct blood tests ordered to find out (August 4) that our dog during boarding was infected with Rocky Mountain Spotted Fever (RMSF). Both second opinion Vets stated that the enlarged bladder would have been a secondary effect to the neurological infection and that the enlarged bladder (or urinary tract infection) would never cause sudden ataxia. Veterinary and human research also support their findings.
Furthermore, the CDC states that SMZ/TMP may worsen the RMSF infection. Our dog (while under the care of a medical professional - Dr. ****) had to endure a minimum of 5 days with RMSF without the proper antibiotic and possibly causing long term neurological effects that we won't know for several more months. We sent a letter to Dr. **** August 5 requesting reimbursement. No response was received, so we sent a second certified letter August 29. Dr. **** called September 2 and felt that his actions did not warrant any reimbursement.
We are requesting $296.84 be reimbursed for the misdiagnosis and initial wrong course of treatment of our dog while under the care of Flint River Animal Hospital. We feel this request is very reasonable and excludes the second opinion and additional laboratory costs. The amount is itemized below. Long term effects from the misdiagnosis and wrong course of treatment are still unknown at this time. We will continue to consult with medical experts to determine long term effects. Corrective treatment of such long term effects deemed directly related to the misdiagnosis and wrong course of treatment may result in additional reimbursement.
$296.84 is calculated from the following expenses:
18-27 July boarding services from Invoice #XXXXX, totaling $229.50
SMZ/TMP Tablets from Invoice #XXXXX, totaling $20.75
Antech Accuplex lab test that excluded RMSF from Invoice #XXXXX, totaling $28.00
SMZ/TMP Tablets from Invoice #XXXXX, totaling $18.59.
Amos is a 4.5 yr old 99 lb neutered German Shepherd and has been a patient and border at Flint River Animal Hospital (FRAH) since October 2011.
Medical History includes leg sprain, overweight and hip dysplasia - an abnormal formation of the hip socket that, in its more severe form, can eventually cause crippling lameness and painful arthritis of the joints.
Pet Owner presented Amos on Friday July 18 for 9 days of boarding while on vacation. Owner signed the Admission Forms and initialed the statement:
" If any medical condition arises during your pet's stay at FRAH Bed 'n Biscuit, attempts to reach you to discuss the condition and required treatments will be made. *** If no contact can be made, I Owner authorize FRAH to treat my pet as needed and will assume costs of provided care." Further statement above signature line stated " I Owner agree to the above discussed terms and allow FRAH to care for my pet as needed". (Signed Admission forms are available upon request.)
The kennel staff alerted Dr. **** after observation that Amos appeared to be having difficulty walking and urinating. On Thursday July 24th radiographs were performed by to rule out any potential orthopedic abnormalities as a cause of Amos not being able to walk, given his medical history. A large urinary bladder was noted on the radiographs. A full CBC, CHEM 17, and Urinalysis was collected and sent to ANTECH diagnostics at the time of the radiographs. The urinalysis was run "in-house" which revealed bacterial urinary tract infection. The urine sediment was read by a licensed veterinary technician as well as Dr. **** to confirm the microscopic results of an active urinary tract infection. The results of the CBC / CHEM would not be returned from the ANTECH Lab for 24 hours. Owner was called and the findings of the radiographs and in-house urinalysis and treatment were discussed at length with Owner with the recommendation to start antibiotics to treat an active urinary tract infection. Owner agreed with all recommendations. Amos was prescribed the proper first line antibiotic SMZ/TMP.
The CBC / CHEM 17 results received from ANTECH diagnostics on July 25th revealed an elevated white blood cell count with neutrophila as well as low platelets (platelet clumping noted within the sample). The blood globulins were elevated as which indicates chronic inflammation which is most commonly due to infection.
Multiple attempts to contact Owner Friday July 25th were unsuccessful due to calls being redirected to his voicemail. Dr. **** and 2 veterinary technicians recall attempting to reach Owner. Owner could not be contacted, so treatment with SMZ/TMP antibiotics for an active urinary tract infection was continued throughout the weekend. Owner picked up Amos Sunday, July 27th.
The ANTECH laboratory results were reviewed with Owner Monday, July 28th. Since Amos's ataxia (impaired voluntary muscle control; condition relating to a sensory dysfunction that produces loss of coordination of the limbs) was not responding to the treatment of the active urinary tract infection it was recommended by Dr. **** that Amos be tested for tick borne illnesses due to the CBC pattern of low platelets and elevated monocytes. Dr. **** recommended beginning minocycline antibiotic therapy as an empirical treatment for tick borne illnesses based upon non-response of ataxia for treatment of active urinary tract infection alone, CBC result pattern, and ongoing ataxia.
Prior to veterinary school Dr. **** was employed by Auburn University College of Veterinary Medicine's Parasitology Lab supporting flea and tick research. Dr. **** has been practicing veterinary medicine for over 12 years and treats approximately 100 cases of tick borne illnesses per year. Dr. **** is very well versed in recognizing the symptoms and successful treatment of illness caused tick borne diseases.
(Dr. ****) Owner's enthusiasm for home research and self education for understanding knowledgeable dialog are commendable but this is no replacement for formal veterinary education, credentialing and experience in correct procedures for observation, diagnostics and treatment of illnesses. Dr. **** recommended diagnostic testing for tick borne illness and to begin immediately minocycline antibiotic therapy based on significant experience treating tick borne illnesses. Owner's claim to have first suggested this to Dr. **** based on home research is absurdly false.
A blood sample for actual diagnostic testing for tick diseases could not be sent off prior to speaking with Owner due to the costs of additional diagnostics being pre-agreed upon by the owner. Upon agreement and go ahead an ANTECH "Accuplex" tick panel was submitted to ANTECH diagnostics. This test is a "quick" tick born disease test where results may be obtained in 24 hours or less. RMSF is a tick born disease that requires specialized testing to document and this test is not included on the ACCUPLEX tick panel. FRAH works with clients to explain procedures and costs and the steps of a systematic information/cost tradeoff diagnostic approach. Owner being cost conscious made the decision to not include the more expensive RMSF test, pending results of the ACUPLEX panel.
The results of the ACCUPLEX tick born disease panel was negative but Dr. **** recommended continuing treatment with minocycline antibiotic based on experience, prevalent clinical symptoms and CBC results. It was explained that most human and animal tick born diseases are treated based on clinical history and symptoms even though laboratory testing may return as "negative". Owner agreed with this recommendation and treatment with minocycline was continued.
Dr. ******** is an ACVS specialist who frequently performs complex surgeries at FRAH. While at FRAH Dr **** requested Dr. ******** to review all the medical evidence and provide a second opinion regarding Amos' condition since Owner demonstrated apparent frustration in the length of time it was taking Amos to respond to treatment. It had been explained to Owner by Dr. **** that minocycline antibiotic was the proper treatment and that that animal's and human's response times to treatment for tick borne illnesses is highly variable and can range from days to months.
Dr. ******** provided a consultation to Owner on Thursday July 31st. Dr. ******** reviewed the radiographs and previous lab work and recommended the continued treatment with the minocycline antibiotic for tick born disease. Dr. ******** also recommended and prescribed the SMZ/TMP antibiotic for 4 additional days to continue treatment for urinary tract infection. Dr. ******** also recommend repeating the previous CBC / CHEM analysis to compare results to the previous lab results, and recommend specifically testing for RMSF since the ACCUPLEX tick panel did not test for this disease and to possibly "put a name on the disease" that Amos was properly being treated for. Owner agreed at this time to perform the test for RMSF that he had opted out of previously. The convalescent lab results demonstrated increased platelet counts that is consistent with a positive response to treatment for tick borne illness. The specialized testing for RMSF (IFA test -vs- ELISA test on ACCUPLEX) as recommended by Dr. ******** demonstrated the presence of antibodies against RMSF in Amos's serum.
Note: The treatment protocol as originally established by Dr. **** was UNCHANGED by Dr. ******** based on the confirmation of RMSF antibodies. Thus, second opinion confirmed original treatment protocol by Dr. ****.
During the month of August Owner submitted requests to FRAH for reimbursement for boarding, diagnostic testing, and medications claiming misdiagnosis and treatment. Dr. **** denied Owner's requests. Boarding for 9 days is in no way related to Amos's illness and is not refundable. The diagnostic testing and prescribed medications were the proper treatment protocol for both a urinary tract infection and RMSF even prior to diagnostic identification. Proper treatment was confirmed by second opinion by Dr Plunkett. Owner signed Admission Forms authorizing treatment and payment in the event of illness of Amos while on vacation. Costs of proper treatment are not refundable. Owner has no basis for his request.
Upon receipt of this complaint through the BBB Dr. **** called Owner to check up on Amos. Owner reported that Amos has responded to treatment and is doing well and has resumed his pre-illness daily activities. The conversation then turned to the BBB complaint. Dr. **** reiterated that there was no basis for the complaint and that there would be no reimbursements. At that point Owner became belligerent and taunting to Dr. **** and the conversation ended.
Since that conversation Owner has posted his negative and false complaint on multiple social media blogs rather than follow BBB formal review process.
(The consumer indicated he/she DID NOT accept the response from the business.)
Admission Forms do not apply when a patient is misdiagnosed and prescribed the wrong course of treatment, such that the provided care falls below the standard of conduct for veterinarians. Two local veterinarians both diagnosed that an enlarged bladder would be a secondary effect to an ataxia-causing infection and both stated an enlarged bladder by itself is highly improbable of causing sudden acute ataxia. In our private consultation July 31, Dr. ******** never confirmed that Dr. ****'s original July 24 treatment of SMZ/TMP was the correct protocol for the corresponding symptoms.
"In-house" urinalysis results were not provided with the lab results requested by the Pet Owner July 31. Diagnosis and treatment were not discussed at length on July 24, as stated by Dr. ****. The conversation lasted two minutes per AT&T usage history. Same AT&T usage history indicates no calls received from or placed to Flint River Animal Hospital July 25. Also, no voicemails from Flint River Animal Hospital were recorded July 25-27. A veterinarian performing at or above the standard of conduct would have left a voicemail. The following dates and local times are the only Flint River Animal Hospital calls received and placed during this complaint period: 7/24 at 1635, 7/24 at 1849, 7/28 at 0805, 7/28 at 1056, 7/29 at 1141, 7/29 at 1616, 7/30 at 0820, 7/30 at 1035, 8/4 at 1333, 8/4 at 1643, and 9/2 at 0811.
During the 10 minute conversation the morning of July 28, the Pet Owner explained his ataxia research and how tick-borne illnesses were the top result. The Pet Owner asked if the blood drawn July 24 was still available for additional testing. Dr. **** agreed with the research and stated a tick panel would be ordered if blood was still available. Dr. **** never explained that RMSF would be excluded from the tick panel, nor did the Pet Owner ever opt out of RMSF testing.
Dr. **** never explained the cost tradeoff diagnostic approach in the July 28 conversation, nor does the Pet Owner understand why his infected canine needed to endure additional stress and discomfort by travelling back to Flint River Animal Hospital July 28 when his pet had been under the same veterinarian care July 24-27. An experienced and well versed veterinarian in tick-borne illnesses would have properly diagnosed and treated a canine in the four days under his/her medical care. If the tick-borne symptoms were properly diagnosed and treated July 24-27, an orthopedic specialist consultation July 31 and second opinion August 1 would never have been needed.
Acute ataxia suddenly displayed July 24 indicate a high likelihood that Amos became ill while boarded, justifying the reimbursement amount. Last conversation with Dr. **** was 9/2 at 0811 for four minutes, when Dr. **** refused to settle the dispute privately. Dr. **** has not contacted the Pet Owner since the BBB complaint was filed 9/3. Amos has not resumed his pre-illness daily activities and still undergoes evaluation for long-term effects. Local company reviews were posted prior to filing the BBB complaint and only summarize the facts provided in the public BBB complaint. An official medical complaint has also been filed with the Alabama State Board of Veterinary Medical Examiners on 9/18.
Final Consumer Response
(The consumer indicated he/she DID NOT accept the response from the business.)
No proposed resolution was provided in business' 26SEP2014 response. Consumer's desired resolution still applies.
Final Business Response
Complainant's claim is focused on medical issues of diagnosis (Dx) and treatment (Tx). The boarding of their dog Amos is a separate issue unrelated to the health condition of Amos. Thus, the resolution will address these issues separately.
Boarding: Complainant boarded their dog Amos for 9 days while on vacation. All standard boarding services were provided Amos during this time which included feeding, watering, outdoor play and time to pee/poop, cleaning kennel, laundry, dish washing, etc, all to provide a safe, secure and clean environment. These standard services are provided regardless of the health condition of boarders. The fact that Amos became ill during his stay is not relevant to the boarding services provided. Admission forms were signed by complainant stating boarding rates and agreement to medical treatment/payment if pet becomes ill during boarding.
Thus, there will be no reimbursement for boarding services provided ($229.50)
Medical Diagnosis and Treatment: It is unfortunate that Amos became ill during his boarding. However, proper medical protocols of diagnosis and treatment with consultation with complainant when possible were followed upon observation of illness. Details of Dx and Tx were provided in original response. A urinary tract infection (UTI) was definitely present and properly diagnosed via microscopic and chemical/fluid analysis. This was not a misdiagnosis as complainant insists. Proper treatment with antibiotic SMZ/TMP was prescribed and agreed upon by complainant.
When Amos's ataxia condition appeared to not be responding to treatment of UTI Dr. ****, based on experience, recommended testing for tick borne disease and immediately began empirical treatment with Minocycline antibiotic therapy. The initial test panel came back negative. A subsequent specialized test panel confirmed a tick borne illness. This sequential diagnostic testing process of ruling out most probable cause through process of elimination with increasing focus and sophistication of testing procedure is proper protocol in diagnosing a complex illness. Regardless of the timing of diagnosis that finally put a label on the tick borne illness, the empirical treatment (begun before exact diagnosis) with Minocycline was the proper antibiotic treatment.
At Dr. ****'s request Dr. ******** provided an independent second opinion on the Dx and Tx of Amos. Her diagnosis confirmed both a UTI and tick borne illness, with recommended refills to complete 2 weeks of SMZ/TMP and 30 days of Minocycline.
With all due respect to complainant's ability to research and self educate on the medical issues that manifested in Amos while on vacation, complainant is not a veterinarian. Complainant's claim of misdiagnosis and treatment is a false opinion. Sequential Dx and Tx were correct protocols with appropriate antibiotic therapy. Admission forms were signed by complainant stating agreement to medical treatment if pet becomes ill during boarding. Thus, there will be no reimbursement for test panels and antibiotics. ($67.34)
Boarding is a non issue and irrelevant to medical claim. Correct medical Dx and Tx were independently confirmed by two experienced veterinarians. If complainant wishes to pursue medical issue then vetting it through the Alabama State Board of Veterinary Medical Examiners is correct procedure.
Flint River Animal Hospital will respond to ASBVME inquiries as appropriate. No further direct response to complainant will be made.