BEFORE THE ARIZONA STATE VETERINARY MEDICAL. EXAMINING BOARD
IN THE MATTER OF: CASE No.: 22-71
DENNIS WHITE, DVM FINDINGS OF FACT, HOLDER OF LICENSE No. 0885 CONCLUSIONS OF LAW AND ORDER
FOR THE PRACTICE OF VETERINARY MEDICINE IN THE STATE OF ARIZONA,
RESPONDENT.
Vee VeVe Ve Yee YD
The Arizona State Veterinary Medical Examining Board (“Board”) considered this matter at its public meeting on July 20, 2022. Dennis White, DVM (“Respondent”) appeared on his own behalf for an Informal Interview that was held pursuant to the authority vested in the Board by A.R.S. § 32-2234(A). After due consideration of the evidence, the arguments and the applicable law, the Board voted to issue the following Findings of Fact, Conclusions of Law and Order (“Order”),
FINDINGS OF FACT
1. Respondent is the holder of License No. 0885 and is therefore authorized to practice the profession of veterinary medicine in the State of Arizona.
2. On October 28, 2021, “Jazz,” a 14.5 year-old female Australian Cattle Dog was presented to Respondent with concerns that the underside of the dog's tongue was red and possibly infected. Respondent noted the dog had severe dental tartar and sublingual irritation on the left side. There were skin masses on the ventral and right lateral thorax. Blood was collected for testing and an oral evaluation with dental cleaning and possible extractions was scheduled for
November 3, 2021.
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3. On November 3, 2021, the dog was presented to Respondent's associate, Dr. Adams, for an oral evaluation and dental with possible extractions. Blood work previously performed was unremarkable. Complainant reported that the dog was eating and drinking normally. She did not want any teeth extracted unless called for permission. Upon examination, the dog appeared to be an acceptable anesthetic candidate and if was agreed to proceed with the oral evaluation.
4, An lV catheter was placed and LRS fluids were initiated. The dog was pre- medicated with butorphanol and midazolam IM; induced with propofol IV; and maintained on isoflurane and oxygen. Once under anesthesia, full mouth radiographs were taken and an oral exam was performed. No masses or abscessed teeth noted — there was no indication to extract teeth. Dr. Adams stated that the dog had all the signs consistent with canine ulcerative paradental stomatitis (CUPS). She discussed her findings and presumptive diagnosis with Complainant. They spoke about the chronic painful condition that only had one effective treatment which was to extract all teeth. Respondent further advised that although the lesions in the dog’s mouth were typically diagnostic of CUPS, she could not completely rule out autoimmune disease or malignancy without histopathology. Complainant did not want to extract the dog's teeth at that time and declined biopsy of abnormal gingiva. After the dog's teeth were cleaned and polished, she recovered uneventfully. The dog was discharged later that day with Clindamycin 150mg, 60 tablets; give one tablet twice a day for 10 days each month; and BreathaLyser Water
Additive.
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5. At discharge, CVT Beck reviewed the discharge instructions with Complainant including the recommendation to routinely brush the dog’s teeth, administer the oral antibiotics, and add the dental additive to the dog's water.
6. Complainant commented that the dog's breathing was abnormal. CVT Beck stated it was because the dog's throat was sore due to the endotracheal tube. According to CVT Beck, he spoke with Complainant at length regarding the CUPS diagnosis and the complications associated with it. He showed Complainant the pictures taken of the dog's mouth while under anesthesia. CVT Beck advised Complainant to start the antibiotics the next day and Complainant left the premises.
7. On November 4, 2021, the dog was drinking less and showed no interest in food. Later that afternoon, the dog started passing large amounts of bloody, green snot, out of her mouth. Due to the dog not eating, Complainant did not start the antibiotics because the instructions stated to give with food.
8. Complainant called the premises to report that the dog was not eating, therefore, not receiving the antibiotics; furthermore, the dog was passing bloody, green snot. Reception staff stated that there was not a veterinarian available; therefore, technical staff was advised of what was transpiring. Technical staff relayed that the dog was likely passing drool and it would be fine if the dog went another day without antibiotics.
9. On November 5, 2021, the dog was presented to Respondent due to not
eating, passing bloody green mucous drool from mouth, and breathing
abnormally. Complainant was unable to give medication. Upon exam, Respondent noted that the dog had red, inflamed gingiva due to CUPS
infection with increased saliva. Clindamycin 127mg was administered SQ and
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Entyce was dispensed and instructed to give 1.8mL SQ once a day. Respondent recommended Compiadinant to be more aggressive with giving the antibiotic and force feeding.
10. On November 6, 2021, Complainant called the premises to request pain medication. The dog was not eating or drinking — Complainant was force feeding the dog but the dog was resistant. Respondent approved pain medication and dispensed carprofen and gabapentin.
11. The Board concluded that Respondent's conduct fell below the standard of care due to not recommending follow up blood work to assess the patient's condition, failing to recommend hospitalization with supportive care, and recommending at-home care that did not provide for the patient's needs which resulted in further suffering of the patient.
12. On November 7, 2021, the dog continued to be anorexic and lethargic; therefore, Complainant presented the dog to Veterinary Specialty Center of Arizona for evaluation. Dr. Vernasco examined the dog and discovered an oral sublingual mass on the left side with associated purulent oral discharge, severe dehydration, and marked inflammatory leukogram, electrolyte derangements, azotemia, mild anemia and severe hyperproteinemia. The dog was hospitalized for rehydration, supportive care and monitoring. IV fluids were administered along with supportive medications.
13. That evening, the dog's care was transferred to Dr. Podmayer for overnight monitoring and supportive care. The dog remained stable but the fever persisted. Thoracic radiographs were performed and revealed no evidence of pulmonary nodules. Recheck blood work showed improving
hypematremia but worsening hyperchloremia, as well as mild hypokalemia.
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14. The next day, the dog's care was transferred to Dr. Vernasco for continued care. Complainant visited the dog and Dr. Vernasco expressed her concern for an underlying issue that has not been identified. Blood work changes were difficult to fully explain and diagnostics and treatments would likely be extensive and they may make a diagnosis that cannot be treated. After discussion with Dr. Vernasco and visiting the dog, Complainant elected to
humanely euthanize the dog.
CONCLUSIONS OF LAW
15. The conduct and circumstances described in the Findings of Fact above, constitutes a violation of A.R.S. § 32-2232 (12) as it relates to A.A.C. R3-11-501 (1) failure to provide professionally acceptable procedures by not recommending follow up blood work to assess the patient’s condition, failing to recommend hospitalization with supportive care, and recommending al-home care that did not provide for the patient's needs resulting in further suffering of the patient.
ORDER
Based upon the foregoing Findings of Fact and Conclusions of Law it is ORDERED that Respondent's License, No. 0885 be placed on PROBATION for a period of one year, subject to the following terms and conditions that shall be completed within the Probationary period. These requirements include six (6) total hours of continuing education (CE) detailed below:
1. IT IS ORDERED THAT Respondent shall provide written proof satisfactory to the Board that he has completed six (6) hours of continuing education (CE);
hours earned in compliance with this order shall not be used for licensure
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renewal. Respondent shall satisfy these six (6) hours by attending CE in the area of diagnostics and examinations. Respondent shall submit written verification of attendance fo the Board for approval.
2. IT IS ORDERED THAT Respondent shall pay a civil penalty of two hundred fifty dollars ($250) on or before the end of the Probation period. Civil penalty shall be made payable to the Arizona State Veterinary Medical Examining Board and is to be paid by cashier's check or money order.
3. All continuing education fo be completed for this Order shall be pre- approved by the Board. Respondent shall submit fo the Board a written outline regarding how he plans to satisfy the requirements in paragraph 1 for its approval within sixty (60) days of the effective date of this Order. The outline shall include CE course details including, name, provider, date(s), hours of CE to be earned, and a brief course summary.
4, Respondent shall obey all federal, state and local laws/rules governing the practice of veterinary medicine in this state.
5. Respondent shall bear all costs of complying with this Order.
6. This Order is conclusive evidence of the matters described and may be considered by the Board in determining an appropriate sanction in the event a subsequent violation occurs. In the event Respondent violates any term of this Order, the Board may, after opportunity for Informal Interview or Formal Hearing, take any other appropriate disciplinary action authorized by law, including suspension or revocation of Respondent's license.
NOTICE OF APPEAL RIGHTS Respondent is hereby notified that he has the right to request a rehearing
or review of the Order by filing a motion with the Board's Executive Director
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within 30 days after service of this Order. Service of the Order is effective five days after the date of mailing to Respondent. See A.R.S. § 41-1092.09. The motion must set forth legally sufficient reasons for granting a rehearing or review. A.A.C. R3-11-904. If a motion for rehearing or review is not filed, the Board's Order becomes final 35 days after it is mailed to Respondent. Respondent is further notified that failure to file a motion for rehearing or review has the effect of prohibiting judicial review of the Order, according to A.R.S. § 41-1092.09(B) and A.R.S. § 12-904, et seq.
Dated this 24% day a 2022,
Arizona State Veterinary Medical Examining Board Jessica Creager, Chairperson
Victoria Whitmore, Executive Director
Original of the foregoing filed this ae day of Bugust, 2022 with the:
Arizona State Veterinary Medical Examining Board 1740 W. Adams St., Ste. 4600 Phoenix, Arizona 85007
Copy of the foregoing sent by certified, return receipt mail this_ 24" day of Auguat _, 2022 to:
Dennis White, DVM Address on file Respondent
6 VWetinaee
Board Staff
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