Dismissal Letter - In Memory of Stempy Munson

Music is: "Stempy" Boy - lyrics below

DISMISSAL LETTER

...and our rebuttal

Greg and Cindy Munson
xxxxxxxxxxxxxx

xxxxxxxxxxxxxx

Re: Case No. 06-111; Ann Thomas, D.V.M.

Dear Mr. and Mrs. Munson:

Please accept our condolences for the loss of "Stempy."

At your request, the Board had a third veterinarian review your complaint against Ann Thomas, D.V.M. The reviewing veterinarian agrees with the other two in finding that Dr. Thomas (the "respondent veterinarian") did not violate the prevailing standard of care in diagnosing and treating "Stempy." Although I did not discuss in detail with the reviewing veterinarians the reasons for their conclusion, the following factors may have been considered.

The reviewers emphasized that prior to September 2005, Dr. Thomas' treatment protocols produced good results - "Stempy" responded and improved. Any culpability on the part of Dr. Thomas should only extend from the last visit leading up to "Stempy's" death. The reviewers apparently found no such culpability.

With regard to diet, the reviewers note that Hills G/D can be used in dogs where one suspects both oxalate and struvite stone types. Thus, this diet was appropriate where both stone types were implicated at different times. One reviewer notes that he has observed in his practice that no diet will work 100 per cent of the time to prevent stones. The role of the Hills diet, if any, in the formation of stones in "Stempy" cannot be determined.

Regarding knowledge of "Stempy's" prior seizures, Dr. Thomas professes no knowledge of being told of these events. I know you disagree with this. Apparently nothing was noted in the dog's previous medical records - no exam, discussion of seizures, medications, etc. - that would document seizures as a pre-existing condition.

With regard to patient records, we cannot determine if the photocopied records were improperly altered. Dr. Thomas acknowledges that as a solo practitioner, she often does not have time immediately after surgery or appointments to fully complete the records. It is permissible to clarify, correct or add to records after the time of services, as long as there is no intent to falsify them or prepare bogus defenses to possible complaints. As a matter of policy, the Board often encourages veterinarians to maintain complete and detailed patient records. There is no evidence, per se, of improper alteration, and we simply cannot make a finding in this regard.

Dr. Thomas reported that the surgery was successful. She said she performed a perineal urethrostomy on "Stempy." Actually, she probably performed a urethrotomy since you did not find a permanent opening into the urethra. In any event, the surgery resulted in removing the stuck stone. A radiograph determined that no stones remained. The dog's condition was initially satisfactory except for reported pain and restlessness. Acepromazine was prescribed to calm the dog. You are correct that this medication should be avoided in animals with a history of seizures or epilepsy; however the issue remains whether Dr. Thomas was aware of the prior history. You say you told her; she says you did not. Neither the dog's former patient records or Dr. Thomas' records mention this history.

The unfortunate bottom line is that the reviewers do not know why "Stempy" died. A necropsy would possibly have answered this question. Possible rule-outs included (1) thrombic emboli in the lungs, especially since the dog had some mitral valve issues; (2) adverse reaction to any of the drugs administered; or (3) a neurological disorder.

In summary, we cannot conclude that Dr. Thomas' actions contributed to "Stempy's" death or that she did not meet the standard of care of an average veterinarian in Mesquite, Texas. All three reviewers agree on those points. This case will be finally closed to no violation.

Sincerely,

Lee H. Mathews

General Counsel

Highlighted sections indicates what is being responded to in red font by us.

Greg and Cindy Munson
xxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxx

8/3/06

Re: Case No. 06-111; Ann Thomas, D.V.M.

Dear Mr. and Mrs. Munson:

Please accept our condolences for the loss of "Stempy."

In any review of a complaint, the reviewers try to focus on the "big picture," that is, whether the veterinarian's actions or inactions, taken in totality, clearly violate the approach an average veterinarian in the same or similar community would have taken, given similar facts. ***MUNSON RESPONSE: Through our own personal research and discussions with other local veterinarians and also with one of, if not the world’s, foremost veterinarian authority on the subject, we conclude that Dr. Thomas did clearly violate the STANDARD OF CARE and approach an average veterinarian in the same or similar community would have taken, given similar facts. We submitted a letter from a local veterinarian stating normal protocol and Dr. Thomas did not follow normal protocol.*** Keep in mind that a reviewing veterinarian may conclude that he would have done some things differently, but this does not mean that the respondent veterinarian violated the standard of care by doing things her way. The standard of care can be multi-faceted. Remember also that the respondent veterinarian's recollection of events may sharply disagree with the complainant's. This makes it extremely difficult to sort out the facts in many cases. …***MUNSON RESPONSE: so the Board makes ABSOLUTELY NO EFFORT to sort out the facts fairly. The only people collaborating on the appeal are veterinarians….the respondent veterinarian and the reviewing veterinarians. The complainant is never privy to these collaborations in order to dispute inaccuracies. In fact, if complainant had attempted to personally contact the reviewing veterinarians, the Board would have immediately dismissed the complaint and / or appeal. This “review” process is ONLY looking out for the interests of the respondent veterinarian. There is NO ONE looking out for our pet’s interests in these collaborations. Why else would the complainant be completely silenced by the Board and allowed no contact with the reviewing veterinarian/s? This must clearly mean that the Board feels ALL veterinarians are above reproach. We are expected to “trust” that the Board gave all evidence and information we submitted to the reviewing veterinarians. How can we trust the Board, when Investigator Barker blatantly lied about calling and speaking with Cindy and then even MADE UP a conversation? Subpoena the long distance phone records for the Board. It will prove our accusation. In our opinion, Investigator Barker should be immediately terminated from employment with the Board….his blatant disrespect and total disregard of ethical behaviour is inexcusable.***

The reviewers emphasized that prior to September 2005, Dr. Thomas' treatment protocols produced good results - "Stempy" responded and improved***MUNSON RESPONSE: Is that so? And what records would back up what the reviewers emphasized? Certainly not the records that we received and submitted to the Board. Those records prove the exact opposite. Perhaps clarification could have been made had the complainant been given an opportunity to directly communicate with the reviewers. If the respondent veterinarian is allowed contact with the reviewers, so should the complainant be allowed contact.*** Any culpability on the part of Dr. Thomas should only extend from the last visit leading up to "Stempy's" death. The reviewers apparently found no such culpability. ***MUNSON RESPONSE: We can only conclude that there must not have been a complete or impartial review. We’ll never know exactly what was reviewed.***

With regard to diet, the reviewers note that Hills G/D can be used in dogs where one suspects both oxalate and struvite stone types. Thus, this diet was appropriate where both stone types were implicated at different times. ***MUNSON RESPONSE: Training material will be sent out to the reviewers. Where one suspects both oxalate and struvite stone types, the diet for oxalate TAKES PRECEDENCE, therefore the CORRECT diet should have been Hills U/D. Again, training material will be sent to the reviewers.*** One reviewer notes that he has observed in his practice that no diet will work 100 per cent of the time to prevent stones.***MUNSON RESPONSE: Oh, really? Well, then, that kind of makes quarterly urinalyses and twice yearly radiographs EVEN THAT MUCH MORE IMPORTANT!!!! The reviewer proves our point. Where is the intelligence in this undertaking on the part of the Board? Is this just a BLATANT cover-up? *** The role of the Hills diet, if any, in the formation of stones in "Stempy" cannot be determined.

Regarding knowledge of "Stempy's" prior seizures, Dr. Thomas professes no knowledge of being told of these events.***MUNSON RESPONSE: That’s because she FAILED to record this CRUCIAL information in his records when we told her on 11/1/03. I know you disagree with this. Apparently nothing was noted in the dog's previous medical records - no exam, discussion of seizures, medications, etc. - that would document seizures as a pre-existing condition.***MUNSON RESPONSE: Just exactly what did the Board review? We CLEARLY stated that Dr. Thomas was the ONLY vet we had EVER told of these occurrences.***

With regard to patient records, we cannot determine if the photocopied records were improperly altered***MUNSON RESPONSE: Then why didn’t the Board request the ORIGINAL records?. Dr. Thomas acknowledges that as a solo practitioner, she often does not have time immediately after surgery or appointments to fully complete the records.***MUNSON RESPONSE: That is VERY conducive to forgetting crucial information by not immediately recording what is told during appointments and examinations, SUCH AS FORGETTING BEING TOLD OF STEMPY’S PRIOR SEIZURE/EPISODE HISTORY and NEVER recording it. It is permissible to clarify, correct or add to records after the time of services, as long as there is no intent to falsify them or prepare bogus defenses to possible complaints. ***MUNSON RESPONSE: There is CLEAR intent on the part of Dr. Thomas to falsify them and prepare bogus defenses. As a matter of policy, the Board often encourages veterinarians to maintain complete and detailed patient records. There is no evidence, per se, of improper alteration, and we simply cannot make a finding in this regard.***MUNSON RESPONSE: With this being SERIOUSLY questioned by the complainant, why would the Board not request the ORIGINAL records? There lies your evidence!

Dr. Thomas reported that the surgery was successful. ***MUNSON RESPONSE: The MAJOR issue that the surgery was UNAUTHORIZED is not even addressed. She said she performed a perineal urethrostomy on "Stempy." Actually, she probably performed a urethrotomy***MUNSON RESPONSE: Dr. Thomas is not even knowledgeable enough to know which unauthorized procedure she performed, yet the FACT that she FAILED TO REFER this case to a specialist is not even addressed. since you did not find a permanent opening into the urethra. In any event, the surgery resulted in removing the stuck stone. A radiograph determined that no stones remained.***MUNSON RESPONSE: No radiograph was EVER taken post surgery. As noted in the records, the only radiographs taken were just immediately prior to surgery, NEVER POST SURGERY. If it’s not in the records, then the Board presumes it DID NOT occur. Isn’t that what the Board is presuming with regards to us telling Dr. Thomas of Stempy’s seizure history? The Board can’t have it both ways, can they? Unfairly and unethically they sure can.*** The dog's condition was initially satisfactory except for reported pain and restlessness. Acepromazine was prescribed ***MUNSON RESPONSE: Then what justified taking him completely OFF of pain killers and prescribing a tranquilizer that provided absolutely ZERO analgesia? to calm the dog.***MUNSON RESPONSE: He was not excited. He was in SEVERE PAIN! You are correct that this medication should be avoided in animals with a history of seizures or epilepsy; however the issue remains whether Dr. Thomas was aware of the prior history. You say you told her; she says you did not. Neither the dog's former patient records or Dr. Thomas' records mention this history.***MUNSON RESPONSE: Previously addressed.

The unfortunate bottom line is that the reviewers do not know why "Stempy" died. A necropsy would possibly have answered this question. Possible rule-outs included (1) thrombic emboli in the lungs, especially since the dog had some mitral valve issues***MUNSON RESPONSE: No tests were ever done. This could very well have been a direct result of an extended urethral obstruction. ; (2) adverse reaction to any of the drugs administered; or (3) a neurological disorder.

In summary, we cannot conclude that Dr. Thomas' actions contributed to "Stempy's" death or that she did not meet the standard of care of an average veterinarian in Mesquite, Texas***MUNSON RESPONSE: We can…and we do conclude that Dr. Thomas' course of actions caused "Stempy's" death and that she did not meet the standard of care of an average veterinarian in Mesquite, Texas. All three reviewers agree on those points. This case will be finally closed to no violation.

Sincerely,

Lee H. Mathews

General Counsel

***MUNSON RESPONSE: We STRONGLY feel that the complainant MUST be allowed to communicate DIRECTLY with the reviewers. How else are we to know that our complaints truly receive a thorough and impartial review? We have tons of questions that have been left unanswered. Stempy certainly did not receive a fair shake. That both saddens and infuriates us deeply.

Greg & Cindy Munson.

"Stempy" Boy

Oh Stempy boy, the pipes, the pipes are calling
From glen to glen, and down the mountain side
The summer's gone, and all the flowers are dying
'Tis you, 'tis you must go and I must bide.
But come ye back when summer's in the meadow
Or when the valley's hushed and white with snow
'Tis I'll be here in sunshine or in shadow
Oh Stempy boy, oh Stempy boy, I love you so.

And if you come, when all the flowers are dying
And I am dead, as dead I well may be
You'll come and find the place where I am lying
And kneel and say an "Ave" there for me.

And I shall hear, tho' soft you tread above me
And all my dreams will warm and sweeter be
If you'll not fail to tell me that you love me
I'll simply sleep in peace until you come to me.

I'll simply sleep in peace until you come to me.

If you love your pet, NEVER blindly trust your vet!