Complaint Review: All Creatures Animal Hospital - Dr. Garlinghouse - Montclair California

As the veterinarian being accused of medical malpractice, I would like to address the highly emotional and extremely inaccurate statements made by this individual. I would also like to point out that in fact, the person making these claims was not present for any exams or conversations and obtained all of her information secondhand through an equally emotional and misinformed family member, thus compounding the overall inaccuracy of their conclusions and opinions. Several months ago, the owner of this dog brought her into my hospital stating that the dog in question was tilting her head and walking in a circle, indicating this geriatric dog was possibly suffering from one of several common conditions. I very carefully carried out several diagnostic procedures, including the appropriate tests to rule out an injury to the eye itself. As this particular test indicated no abrasions to the cornea of the eye at that time, I prescribed several medications, including an antibiotic ointment which also provided a very mild steroidal ingredient to help reduce inflammation, which AT THAT TIME, was the medically appropriate treatment. Three days later, I arrived at the hospital after a day off and was immediately told there was a phone call from the owner. Completely unaware of any recent changes or problems, I was very surprised to be subjected to an irate rampage from the owner, accusing me of harming her dog's eye through misdiagnosis and providing the wrong medication. At this time, I learned for the first time that her dog's eye had worsened, it had been re-examined by the associate veterinarian at our hospital, who had diagnosed a corneal abrasion where my own examination had found none previously. During the re-examination, the previous prescribed medication was discussed as now being inappropriate, and replaced with a straight antibiotic ointment, which was the correct medical decision to have been made under these new circumstances. During this conversation, I told the owner that I had not spoken to the associate vet, had not yet reviewed any records describing the new findings, but said that I would be very surprised if I had missed any injuries which had existed three days previously. I specifically said that if I HAD made a mistake (which in fact, I had not), then I apologized profusely for doing so. The owner insisted that the current injury could not possibly have occurred in the past three days, and was not interested in my observation that indeed, rubbing at an inflamed eye and causing a subsequent injury is a very common occurrence. On reviewing the medical records after this conversation, I saw that the newly diagnosed corneal abrasion was centrally located in an area of the eye that I had carefully examined previously, which confirmed my suspicions that in fact, the abrasion had NOT existed during my initial examination. I also noted, and then confirmed through independent veterinary sources, that two days of the original eye medicine I had prescribed would have caused no significant long term damage to the eye. While the replacement ointment prescribed by my associate was indeed an appropriate choice given the new injury, it is extremely inaccurate to conclude that the previous medication had anything to do with the eventual loss of the eye. The owners continued to bring their dog back to the hospital for the associate veterinarian to monitor. I did not personally see the dog, but reviewed the ongoing medical notes that the eye was apparently healing well. During this time, the dog traveled with the family out of state, and obtained a refill of the antibiotic ointment after examination from a third veterinarian. Neither this out-of-state veterinarian, or myself during my initial examination, saw any indications that there was an underlying problem with glaucoma. After several months of treatment, the owner called my hospital just before closing and said that her dog's eye appeared to indicate a new problem. As Dr. Lanini was off-duty and unreachable by phone, and I had left early for an appointment out of the area, neither were immediately available to examine the dog. It was recommended that the owner take her pet to the area's emergency center where we refer animals requiring after-hours emergency care. It was explained to the owner that the new symptoms she was observing may be either inconsequential or serious, but there was no way of ascertaining this without an examination. It was also discussed with the owner that the emergency center occupies the same building as a veterinary ophthamologist (an eye specialist), and we recommended their input as well for the welfare of the pet. The dog was examined that night and again soon thereafter by the eye specialist and diagnosed as suffering from primary glaucoma, a chronic condition caused by abnormally elevated pressures within the eye. These elevated pressures caused secondary damage to the lens, and it was recommended that the eye be removed surgically, which was done successfully. The report of the eye specialist, provided in writing to our hospital, indicated that this condition was a long-standing chronic disease which previous treatment had neither caused nor adversely affected. Ironically, the ointment originally prescribed is one of the medications commonly used for the treatment of glaucoma, though the presence of glaucoma was not known at that time. It was clearly explained by the eye specialist at that time to the owner that her perception of my "misdiagnosis" was incorrect and while the change from one ointment to another was indicated and appropriate at that time, the original medications provided had nothing whatsoever to do with the current condition of primary glaucoma. It was also discussed that the same disease would be soon causing the same conditions of progressive blindness in the OTHER eye, which had never been injured or treated by us throughout this interval. In other words, the owners claim that my treatment caused the glaucoma and loss of the eye, yet do not explain why the same disease also exists in the other uninjured, untreated eye. While an injury to the cornea can cause a secondary trauma-related glaucoma, this dog was diagnosed with PRIMARY glaucoma---essentially a congenital, age-related eye disease which had been smoldering and slowly progressing for a very long time and had nothing to do with the initial treatment or medications prescribed. The owner was apparently not satisfied with this particular opinion of a board-certified veterinary ophthamologist and continues to choose to erroneously place all blame for her animal's problems on me, despite all evidence to the contrary. Despite examinations by three different veterinarians, no previous indications of primary glaucoma had been noted until the night when emergency care was recommended. Symptoms consistent with glaucoma were not present when I originally examined the animal, therefore was not tested for at that time (just as I also did not perform tests for a broken leg, liver disease or alien abduction, since there was no indication to do so). After the surgical removal of the eye, the owners approached our hospital administrator with their complaints, continuing to claim that all eye problems connected with their dog were solely due to my initial examination and treatment several months earlier. Upon reviewing records, it was apparent that while no indications of glaucoma existed during my initial examination, reasonable symptoms did possibly exist later during our associate veterinarian's follow-up visits, but no tests for glaucoma were performed during those visits. No tests for glaucoma were performed at the out-of-state veterinarian's office, either, but that's another issue that has nothing to do with our hospital. Because the dog's owners have been long time clients of this hospital, and because of the highly emotional issues involved, the hospital administrator agreed to reimburse the owners for their dog's medical care to put the issue behind all of us and in the interest of good client relations. This was done not because I myself was "admitting" any mistakes, but because during the follow-up visits, indications of glaucoma apparently started to appear and were not followed up on by the associate veterinarian as, in hindsight, they probably should have been. Would earlier diagnosis have made any difference in the dog ultimately losing her eye---no. Would earlier diagnosis have slightly delayed the ultimate loss of the eye, possibly. While these opinions are stated here as my own, they are also supported by the records provided by the board-certified veterinary eye specialist, and also well-supported in textbooks on ophthamology. I continue to stand by my personal diagnosis and treatment plans at each point in time. As I am the owner of this facility, the buck stops with me, regardless of which individual on my staff made a mistake. I could well have invited the owners to submit their erroneous accusations to my professional liability carrier, who has told me that I had no personal obligation to financially reimburse these owners, and that my carrier would have strenuously defended my professional conduct and decisions. I took financial responsibility out of sympathy for the chronic, congenital and virtually "unfixable" disease affecting their dog, for their emotional distress and because they had been long time clients of our hospital. I felt and demonstrated loyalty to my clients which they have chosen not to return. Despite taking financial responsibility for the dog's medical treatments, I absolutely deny that there was any personal wrongdoing, lack of judgment or medical malpractice on my part---were I presented with exactly the same set of circumstances again, I would act in EXACTLY the same way; by carefully performing appropriate diagnostic tests, prescribing the appropriate medications called for AT THAT TIME and continuing to provide compassionate and qualified care for my patients and their owners. It is unfortunate that this family's dog has lost eyesight in one eye and will almost certainly eventually also lose sight in the other eye, regardless of treatment even provided by a specialist. It is also unfortunate that there are no guarantees against medical circumstances can can unexpectedly change within a few months, a few days or even a few hours, indicating that changes in treatment should also take place. Such is the dynamic nature of veterinary medicine. If the individuals making these erroneous accusations are aware of where a crystal ball can be obtained to predict and forestall such changes, I would sure like to know where I and every other medical practitioner on earth can get one. Dr. Susan Garlinghouse, DVM All Creatures Animal Hospital

The client report on this incident was apparently submitted while she was still in a state of shock and anger as a result of the patient's condition and before she had discussed this matter with the Hospital Administrator. Due to the unforseen nature of the patient's condition, it was difficult for the client to understand that the condition that resulted in the loss of the patient's eye was completely unrelated to the condition for which All Creatures Animal Hospital treated the patient. We knew that the client had attempted to provide the best quality of care for the patient, as did the Hospital, so we paid for all of the medical expenses related to this patient's eye, even though neither Dr. Garlinghouse nor Dr. Lanini provided anything to this patient other than the highest quality of care. The patient's original eye problem was an infection that was treated correctly by Dr. Garlinghouse. Diagnostic eye tests were completed that indicated that nothing more than the infection existed in the eye. When the patient was brought in again, the infection had resulted in the patient scratching at the eye and producing an abrasion on its surface. Dr. Lanini correctly diagnosed and treated this condition for several weeks. The client took the patient on an out-of-state trip during the period Dr. Lanini was providing treatment and a veterinarian in another state examined the patient. Again, this third veterinarian agreed that the irritated eye required the medication prescribed previously and added another dosage for the patient. Due to the irritation of the eye, the patient continued to scratch at it, producing a red and swollen eye. The client took the patient to the Emergency Pet Clinic and during that examination, the patient was found to have accute glacoma in addition to the irritation. The intraoccular pressure resulted in permanent injury to the vision and the eye was removed as non-functional. The glacoma had not been present prior to this time. This is evidenced by the fact that neither Dr. Garlinghouse nor Dr. Lanini noted any symptoms of glacoma. (Recall that Dr. Lanini had provided nearly all of the patient's treatment at our practice for several weeks. Dr. Garlinghouse had only seen the patient once. Yet the client recommends Dr. Lanini, who arguably should have noted the glacoma had it been a chronic condition.) Although this may appear to be self-serving evidence, also note that an independent third-party veterinarian, without any bias from prior examinations or patient record notations, also did not note glacoma in the patient. Glacoma is a congenital disease in this particular breed and the opthalmologist who treated the glacoma noted that it is inevitable that the patient will also eventually lose sight in the remaining eye as well. Neither infection nor abrasion to the eye CAUSES glacoma. Had none of the three veterinarians provided ANY treatment to the patient during this period, the accute glacoma would have STILL resulted in the loss of sight. Furthermore, the client's statement here indicates that somehow Dr. Garlinghouse provided the incorrect treatment to the patient and that treatment allegedly damaged the patient's eye. Glacoma is NOT caused by any of the treatments provided by any of the veterinarians who saw this patient prior to the emergency room visit. If I have an ear infection that causes my head to ache near the ear, and I receive ear drops for the infection, but I later develop a tumor in my brain near that ear, the ear drops are not the cause of the tumor. The same thing is true here. It is also unreasonable to state that Dr. Garlinghouse "singlehandedly" misdiagnosed the patient's condition. For the sake of argument, had the patient displayed long-term symptoms of glacoma, then Dr. Lanini, who treated the patient for several weeks, logically should have been the individual who failed to detect the condition during her many examinations of the patient's eyes. Yet the client feels that Dr. Lanini is the veterinarian whom she would trust to continue to treat her pet. As indicated previously, three separate veterinarians did not see any indications of chronic glacoma, as these signs were not there to see. No one improperly diagnosed this patient. As indicated before, All Creatures Animal Hospital did not want the client to suffer both the cost of the treatment and the loss of their beloved animal's health. While there was nothing that All Creatures Animal Hospital could have done differently for this patient, we sympathsized with these long-time clients and paid for all of the medical treatment provided to the patient. The comments regarding admissions by the veterinarians as to any mistakes, as well as the statements regarding any financial damage to the client, are emotional outbursts stimulated by the client's sudden confrontation with this terrible disease state and are not factual. (Dr. Garlinghouse certainly does not view dogs and cats as "dispensable" [sic] having a house filled with 5 dogs and 4 cats.) We trust that this client would tell a different story now and we will be pleased to show anyone documentation of the Hospital's payment of the client's medical charges. As a member of the Better Business Bureau, All Creatures Animal Hospital invites anyone to review our rating with that organization. We provide only the finest veterinary care and invite you to tour our facility and talk with our staff.