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ARIZONA STATE VETERINARY MEDICAL EXAMINING BOARD 1740 W. ADAMS ST., SUITE 4600. PHOENIX. ARIZONA 85007 PHONE (602) 364-1PET (1738) FAX (602) 364-1039 VETBOARD.AZ.GOV
COMPLAINT INVESTIGATION FORM
if there is an issue with more than one veterinarian please file a separate Complaint investigation Form for each veterinarian
PLEASE PRINT OR TYPE
Date Received: Case Number: __
A. THIS COMPLAINT IS FILED AGAINST THE FOLLOWING: Name of Veterinarlan/CVT: DZ. ChHUSTINE McCormMicic Premise Name: COPPEx (0G Eeuiné Spoeis Meoicwe t Sucoeey Premise Address: 37506 N. (( 74 Ave .—«s—s§»_— <—a City: _PitoB AY State: Az Zip Code: O9086 ss Telephone: (400) 28l-56%3-
B. INFORMATION REGARDING THE INDIVIDUAL FILING COMPLAINT*: Name: SAMI # TEUS ENCES Be geet , are ae - :
Address: . z peu 5
Ci) —, State: am
Home Tele phone:(¢ :
"STATE LAW REQUIRES WE HAVE 70 DISCLOSE YOUR NAME UNLESS WE CAR SHOW THAT DISCLOSURE WiLL RESULT IN SUBSTANTIAL HAR? TO YOU, SOMEONE ELSE OR THE PUBLIC PER A.RS, § 41-1010. 1F YOU HAVE REASON TO BELIEVE THAT SUBSTANTIAL HARM Will RESULTIN DISCLOSURE OF YOUR NAME PLEASE PROVIDE COPIES OF RESTRAINING ORDERS OR OTHER DOCUMENTATION.
C. PATIENT INFORMATION (1): Name: Pig Sioe MeCue Breed/Species: (forS = = Age: (4 Sex. Fs CColor: IARI. BAY
PATIENT INFORMATION (2):
Name:
Breed/Species:
Age: Sex: C olor:
D. VETERINARIANS WHO HAVE PROVIDED CARE TO THIS PET FOR THIS ISSUE: Piease provide the name, address and phone number for each veterinarian.
De ALYSSA BUTLER (480) 766-2163
E. WITNESS INFORMATION:
Please provide the name, address and phone number of each witness that has direct knowledge regarding this case.
TEAN SIMMONS (En
Attestation of Person Requesting Investigation
By signing this form, | declare that the Information contained herein is true and accurate tothe best of my knowledge. Further,! authorize the release of
any and all medical records or information necessary to complete the investigation of this case.
instead Pelad lens dudes Date: 6/19 / 2.09.0
F. ALLEGATIONS and/or CONCERNS: Please provide allinformation that you feelis relevantto the complaint. This portion must be either typewntten or cleany printed in ink.
ATTACHED (5 (He CETTE? WE SEAT Copper Rip6E Equus DETAIUNG our CASS-
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June 26, 2020 Dr's Justin & Christine McCormick:
It is quite apparent that Sage and her foals care were grossly mishandled, due to obvious incompetence and negligence. Sage was my special horse and soul mate, and our family. | wasn’t able to ride Sage any more so | wanted her foal to raise and-show and ride. We were lucky to get this breeding to a world champion stallion and were looking forward to a show future for the foal. We trusted you with her care. A stomach tube should have been inserted immediately and left in for feeding purposes. This would have enabled the tech to feed him properly without a chance of aspirating fluid . He was not getting enough nutrition, with only a cup of formula every few hours. He was aspirating it into his lungs. I have a picture of his nose in the bucket with several inches of formula in it. Christine finally tubed him the third day he was there, but by-then it was too late. When the baby was dying, Christine told me he had milk in his lungs. When she was trying to resuscitate the foal, she told the tech to go get some oxygen. The tech wandered back to the stall after the baby had died with a huge oxygen tank on a dolly. Christine came to me in a state of panic in the middle of doing CPR saying that the milk got into the lungs. You should not leave the foal in the middle of doing CPR. She should have called for assistance.
Its unbelievable that a large clinic like Copper Ridge doesn't have portable oxygen tanks available. They also didn't have any cameras in the stall where Sage. and the baby were. It was hot.out and the fan wasn't on. We had to turn it on ourselves. They should have been monitored more closely, not every three hours. We also noticed meconium present after the baby died. | asked Christine if she gave the baby an enema when he was delivered:and she said yes, but there should not be an meconium after three days. | have delivered 18 plus foals and their meconium came out within 5 hours after birth.
When | brought dead Avatar in the back of our car, | asked the vet to bring Sage to the car. Christine said no because she thought Sage wasn’t attached to Avatar because she did not nurse him. | told her that Sage loved her baby. Christine was wrong and Sage did get so upset that we
brought her to see Avatar. She was upset. Then | asked Christine if | could stay with Sage because we are soulmates and | knew she would feel lonely. Around 11 pm Sage died with stitches bursting open. Neither vet knew why. If 1 would have been allowed to stay with Sage that would not have happened. ! found that was strange. The vet didn't have sense enough to understand the horse behaviors. She was never prepared for all this happening.
That same night Christine called me at midnight and told me Sage had died. She didn't say how, just that there was no sign of a struggle and they found her dead after not checking on her for three hours. Evidently her stitches failed. | don't think you were being honest with us when you told us you didn't know what happened with Sage. You said Sage didn't need to be in and ICU stall. She had been cut open. That needs constant monitoring.
There were several other people who witnessed the situation who are knowledgeable in horse care who agree with our observation of your handling of our horses care. We also have talked to several vets and horse breeders and they agree that you were totally incompetent.
You made some terrible mistakes and misjudgments and this has to be corrected. You killed my mare and my baby. We are traumatized that because of your negligence we lost our beloved Sage and her foal Avatar. Consequently ,with two dead horses and less than adequate care, we will not be paying the bill. We hope you can understand our situation and anguish over the loss of our two horses and find it in your hearts to eliminate any charges to us. If this isn’t rectified and the charges eliminated, we will be forced to seek legal council.
8/27/2020 Scan 0.jpeg
COPPER RIDGE EQUINE = gj_j2., 13
SPORTS MEDICINE & SURGERY:
-3120 W:Carefree Hwy Suite 1 639 Phoenix, AZ-85086 |. 480-281-5682 | info@cridgeequine.com
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‘Dear Sandi and Terris Inches, aU bmi
‘August 25,:2020:
ECEIVE
Sandi and Terris inches
AST,
In consideration of your letter dating June 26, 2020, and phone conversations thereafter, we are issuing the. following reply. We.took your allegations: seriously and completed a.thorough review of the veterinary care provided i in this -matter. We concluded. that none of veterinary care or services.fell below. the applicable standard of care. in answer. to the specific accusations made regarding incompetent and negligent medical care, -please see-your opinion in black and our response In blue.
“A stomach tube should have been inserted immediately and left in for-feeding purposes. :This would have enabled. the tech to ‘feed him properly without.a chance of aspirating, fluid, “
From the begirining, the Inches were counseled to be prepared for ar-abnormal or non viable foal. They were advised there is likely developmental problems with the foal causing the foal ta not signal partition (labor) inthe mare. The foal was reportedly : 20+ days overdue and.every: .day a foal goes overdue the placental insufficiency can increase, CAUSiN ED developmental problems in the foal to.get worse and worse with each pas ssing day, Pastmatura foals (overdue foals) are predisposed.to a myriad of health issues including gastrointestinal, metabolic, and endocrine dysregulation, The mare did not have any milk so the decision was.made to try allowing the foal to eat. for himself Trom abucker. The reasons for choosing this method first-are as follows:
1. The foal had a weak suckle-swallow reflex which can predispose then, to uncoordinated swallowing and aspirating milk into their lungs, There is always an increased risk for. aspiration if an ior maladjusted
foal. The head and larynx: position when drinking from a: ‘bucket, as opposed toa bottle, decresses the risk-
of aspiration: Allowing. the. fodl-to Attempr te dink an his awn will stimulate increased coordination of ‘swallowing a8 well as stimulate BAS stréintastinal hialth and motility in: the most natural way pos sible. 2. Stomach tube placement does not come: ‘without the following, risks: Jaryngeal trauma, fastrointestinal trict infec tion, aspiration if the foal’ dislodges the'tube, tube failure, colic. tris notindicated to ‘immediately place an indwelling feeding tube when there is-a chance the foal cafi eat an his awn.
“He was not getting enough nutrition, with only a.cup of formtila every few hours. He-was aspirating it into his lungs. | have a picture-of his'nose in the bucket with several inches of formula in it.”
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8/27/2020 Scan 2.jpeg
The. foal died. froma single incident of milk aspiration, at 3: 30pm on: May 10", he was not aspirating milk into his lungs every time: he. dunked hie:nose in the bucket while eating. iF this, were true the foal would have ‘been battling aspiration pneumonia from the start, itis normal for bucket fed foals to dunk. their nose. intermittently while eating: without harry.
As. for nutrition; the féeding plan was meticulously: written, monitored; ‘and recorded ‘to follaw: ‘industry standards, He did: not meet-our projected. goals. for: milk: intake and the. placement of a feeding | tube was consid@red at-every step. For'the Fallo. wing reasons, tube: feeding was not initiated uatit:- lam on: May Loth:
1, itis: well published. and well agreed, upon by internal medicine Specialists that'the risks.of ayerfeeding a matadjuste 9 al greatly outweigh the risks at underfeeding. ‘Some. experts even prefer to approach these foals: vithya hypocalaric plan: understandi ng” that all thei ends may nét-be niet, yet-to: avoid: the ‘detriment onsequences of overfeeding. Th rability: ‘of this foal to appropriately diges it and metabollze ihe Auitrients provided Was riot guaranteed and therefore’ makes: overféeding a very: ‘real concérn..
2. The benefits of allowlig him to-eaton his own Were carefully weighed against the risks of tube feediag or an. indwelling feeding: tobe,.
3.5 His vigor to eat and. smaunt! consumed varied fron feeding to feeding make the décisian less:
straightforward:
“Christine finally tubed ‘him on. the third day he was there, but by:thein it was toolate.””
This foal did not-dié. of starvation. “His bloodwork at 3p on, May 10th. {ane hour before his unfortunate passing} indicated adequate hydration, rigrmat: alectrolytes, and most. importantly normal glucose: level. He was:not starving er dying. ‘His vitals taken at Llant on May 10th were within normal lirnits: indicating. he was notin a critleal, ar dying state.
Ona rélated nate, the owner. and: c linic lange ancerns forthe foats: declining willingness. to stand of eal were of great concern and no p nored. The: foal’ $ bloodwork did. however indicate: low bicarbonate which easily. accounts: for his declining willing 1e5S> | tis common for foals with 3 an impeding. diarrhea to! quickly. lose. bicatbonate and once corrected with flaid therapy. they. regain: vigor almost instantly: Specialist would: attest this foal was likely less. vigorous: ‘due'to low bicarbonate than hypaglycemia ar starvation.
The tow: bicarbonate is ‘alsé furthe vide ee that: this:foal likely: had anjimpending diarrhea; supporting that he was maladjusted: irom: birth. He: Was a. high: risk foal from: this beginning.
“When the. baby: was dying, Christine told. ‘me he had milk’ in his. Jungs. When she was trying to. resuscitate the Foal, she told the tech toga get some oxygen. ‘The tech wandered. back:to the'stall'after. the ‘baby. had died with a: ‘huge oxygen tank ona. dolly, ristine: came’ ‘to, meina state: of: ‘panic in the middle of. doing: CPR. saying | that the: milk got into.the lungs: You should not leave the foal in the middle’ ‘oF doing CPR. She should have: ‘called for assistance.”
When the milk began to discharge from.the feats nose, respiratory arresvensued followed by cardiac arrest: Mouth to nose: resuscitation then’ CPR was initiated. immediately. ‘The critical care: guidelines of ‘ABDC (Airway, Breathing, Circulation, Drugs) were. followed. During: this: tim Ferris | Inches Was near, the Stall but ‘on the phone With a trusted ‘friend - Resus¢i tation.was not inte upted: bul only’ to: strongly.enco rage Terris to get off the phone-so (could: explain’ what was happening: Shé stayed an the: ‘phone déspl asking. the gisidance of the-friend instead of talking with me, There. was:an 335 istant present: Thi assistant j leave to go get oxygen but it needs tobe
uaders stodd that axygen was for the purpose of supporting: thé foal primarily: IF CPR was ‘Successful; netto bring the ‘foal back to life:
“itis unbelievable that. a large cliniclike Copper. Ridge Equine doesn’t-have: portable oxygen tanks available.”
The assistant did-bring:back portable OXYBEN:
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8/27/2020 Scan 3.jpeg
“They also didn’t have cameras inthe stall where Sage and the: baby were. It. was hot out.and the fan wasn’t on. We had to turn it on ourselves. They should-have been monitored more closely, not every 3. hours.”
Sage. ‘and Avatar were handled every Z-haurs. Every two hours Sage Was observed anid the foal was fed-and handled, There were:2: veterinarians on site 24. hours: There was alsd. a technician | in the barh.24 hours. Sage nar the baby were in critiéal’states, The fans are turned on every:morning. during the hot months of the year.
“We also: noticed: meconium. present. ‘after the: baby died. | asked’ Christine is she: gave the baby an enema when he was delivered and she sald yes, but there ‘should. nat be:an: meconium.after 3. days.”
The:foal was givenan enema-after birth and meconium passed:
“When | brought dead Avatar In the back of our.car, | asked: the vet: to bring Sage to the car, Christine. said no because, she thought Sage. wasn't attached to’ ‘avatar because she: did nat nurse'him: Christine was: ‘Wrong and Sage did getisa upset that we brought her to see’Avatar: *
At the. request-of: the Inches {andi in.agreement with them) .the-déceased foal was allowed:to lay In the stall for the mare to acknowledge until: we-all felt ‘appropriate timing: totake him: ‘out and put. him ithe inchés:car. | helped load the-foal into the car when the Inches were. ready. ‘When the foal was taken-out Sage: ‘showed signs, of agitation, s0.we collectively decided 16, bring, her our of the stall and let her: smell and acknowledge the baby for asong-as she needed to. There were absent signsin normal fetal-maternal bonding, Behavior but Ldid not deny allowing her-to acknowledge the deceased foal nar say they wer f Hot attach ed.
“Around 11pm Sage died with:stiches. bursting open; ‘Neither vet knew whi. (fl would-have bean allowed to Stay. with Sage’ ‘that would not’have happened. ” “That same night. Christine called meat midnight ‘and told me. Sage had-died. She didn’t say how, just that:there: was no sign of a ‘Strugete. and. they found her dead after not checking ' on her for.3 hours. Evidentiy her stiches failed. don’t think you were: being honest with us when you told us you ‘didn’t know what habpeneet with Sage...”
sniisual. At midnight check she'was found d decease din Ker stall of unk cause, Hee abdamninal ine ion was partially dehisced.with’s: srnall| portion of her¢olan- expos sed. ‘Unfartunately,’ there were no-externai Indications for the cause of death. Incisional failure was likely not the primary cause of death for the: following reasons: -
1. Her: incision was monitored. Carefully post operatively: and Nevers showed. any gigns of comprenniise. The incisloa was tight and dryand appeared exactly | how vit should post operatively.
3, The amdunt: of exposed. Gl track wasminii covered {nm shavings | nor macer rated If a horse, pviseardtes, they: do aut die Immediately, rhe intestines can be exposed (get dirty, and torn) for several: hours before. sh ck anid. death. ensue. Jdtismuch mare: likely the incision partially dehisced om impact when she'went dow due to her large: Size:
3. The stall was-not heavily ¢ disturbed indicating death wassudden with no-struggle. The state she.was found
in supports: something abrupt: such a heart attackor aneurysm, 4, Otva.more subjective: note;Dr, Justin McCormick has preformed over 1,000 abdominal surgeries in the past 5 years without any incisional failure, A-statistic that far supersedes. most equine surgeons.
A necropsy (post mortem éxain) would have piavided a-cause of death‘but was declined by the Inches. An offer was made. to-havé the Inches cone and see Sage deceased that they also declined.
“You sald. Sage didn’t need to be'in'an.iCU stall. She had been cut open: That needs constant monitoring.”
As proven. in the: medic brecords, Sage did very" val! pos toperatively, ‘She 'never, ‘displayed. any. indication. of being in
criti¢al condition of “needing. intensive care. Her: death was very unexpécted and consistant with an unrelated unifortinate-event.
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8/27/2020 Scan 4.jpeg
On July 27, 2020 Christine reached out to Terris inches and-spoke:with her on the phone regarding the letter.and accusations. | We expressed that we took: their. allegations seriously and completed a comprehensive review of the’ veterinary care’ ‘provided. We. concluded that none'o veterinary care or ‘services fall below the applicable. standard of care.. Christine and Copper. Ridge Equine: expressed their: ‘sympathy: to the unfortunate: outcome: and: eagerness: to work: ‘together: oha financial plan we were’ both. comfortable with: We expressed to. the inches. that:we would gladly glve our time. for. free and hope that: they. could be ‘compassionate. to. the. considerable expense that went. into the elective C- section résources and labor. The surgery ‘alone equired 3: ‘veterinarians: who have’all given their time for
frae-as wellas’ 4 ‘techhicians. We offered. the: jaches the: following: options:
1," Set up.a payment plan that they were: comfortable. with. ‘Any monthly amount ‘that they could provide over any. length of time.
2. 20% off: the total services if the invoice could, be paid in, full:
3. If: the Inches stilt did not think either. of thos were. falt, we encouraged them té-come up with an amount they were ‘comfortable with and we would work together:
Terris Inches: called back the following, day. and. declined all: offers. She. made no offer to work together in any fashion. . She. threatened. she would be posting her letter < on. social media ‘(which was done on Aug 10" and Aug 20") in hopes” that we would change our minds and: negate. her: bill completely.
In conctusion, the deaths of both Sage. and Avatar were very heartbreaking. Our deepest condolences: are still extended to the Inches:-We- understand: the grief ‘and frustration of the loss whole heartedly, as we carry it'too, however the accusations made are not only false but unfounded:
Sincerely,
‘Christine- McCormick; DV
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September 7, 2020
Christine McCormick, DVM Justin McCormick, DVM, MS, DACVS 37506 N 11" Ave 37506 N 11' Ave Phoenix, AZ 85086 Phoenix, AZ 85086
Arizona Veterinary Medical Examining Board 1740 West Adams Street, Suite 4600 Phoenix, AZ 85007
To Whom It May Concern:
in regard to complaints 21-12 and 21-13 filed by Sandi and Terris Inches on August 18**, 2020, please accept this summary of our involvement with this case and the relevant details. Please also refer to Christine McCormicks formal response to the Inches that addresses each of their individual accusations.
During the horse’s hospitalization, all verbal communication was with Terris Inches and she translated everything to Sandi Inches in American Sign Language. There is concern that carefully chosen verbiage and medical terminology was not understood and potentially altered in communication to Sandi inches.
On May 8*, 2020, we received a referral call from Dr. Alyssa Butler. She examined the inches mare “Sage” that morning. She reported that Sage was suspected 388+ days gestation with no signs of impending parturition. The Inches believed labor was starting at 3am the evening before because the mare became uncomfortable. Dr. Butler’s exam revealed normal vitals and minimal feta! movement, so she referred to Copper Ridge Equine for further evaluation.
Our initial evaluation of “Sage” was consistent with Dr. Butlers; no signs of partition, no signs of abdominal pain, vitals within normal limits, and foal movement present on rectal exam. No records were provided by the Inches regarding reproductive history or artificial insemination date, they only reported she was inseminated at Jean Simmons ranch. The options of waiting versus an elective cesarean section, and the risks associated with both were discussed at length with the Inches. Due to the risk of dystocia and adverse effects that increase in severity with each day overdue (1), the Inches elected cesarean section. The Inches were counseled that there is likely a problem with the fetus that it is not signaling parturition in the mare and to be prepared for an abnormal or non- viable foal. If the foal is viable, it will likely need intensive care. No natural colostrum ingestion as well as the sequalae of post maturity make the foal highly predisposed to: sepsis, respiratory compromise and failure, colic, indigestion, ileus, enteritis, umbilical infections, corneal ulcers, endocrine and metabolic dysregulation, muscle hypotonia, aspiration due to poor swallowing coordination, etc. (2).
The surgery was performed that day without complication.
Arizona Veterinary Medical Examining Board 1740 West Adams Street, Suite 4600 September 7, 2020
Page 2
Post operatively the foal displayed characteristics of being post mature. Overall, he was not normal but did show hopeful signs that he would thrive. As documented in the medical records, he was treated with 24 hour (Q2) intensive care. He was never in critical condition during his stay here but did begin to decline in vigor on May 10". The Inches primary concerns are that we did not insert an indwelling feeding tube immediately after birth to provide him nutrition, which they believe ultimately lead to his death. This is not true. The foals feeding regimen was meticulously calculated and recorded according to internal medicine guidelines, and tube feeding was considered at every step. An indwelling feeding tube is not immediately indicated before first seeing if the foal can drink on his own. Bucket feeding was attempted first for the following reasons:
1. Enteral feeding is always preferred for physiologic benefits over parenteral if the Gl tract can tolerate food (3) Head and laryngeal positioning when drinking from a bucket decrease risk of aspiration
3. Drinking on their own promotes strengthening and coordination of a weak suckle-swallow reflex Grave risks are associated with overfeeding a foal that is highly predisposed to GI dysmotility and enterocolitis (4)
5. Risks are associated with maintaining an indwelling feeding tube (5) He intermittently drank well on his own
At 11am on May 10th tube feeding was initiated and he received 2 feedings. The foal had adequate borborgymi and no reflux which suggested he was able to tolerate the feedings but many unknowns make it not absolute. At 3pm on May 10°, due to the foals decline in vigor despite 2 tube feedings, along with bloodwork displaying low bicarbonate and metabolic acidosis, a decision was made to place an IV catheter. The foal would be started on IV fluids to support the cardiovascular system and correct the metabolic derangement. It is important to note at this point that the foal was not dying or in critical condition. His bloodwork indicated adequate hydration, normal electrolytes and normal blood glucose. His vitals taken at 11am were within normal limits. The foal was lightly sedated for catheter placement due to the strict aseptic technique required for a foal at high risk for sepsis. It is highly likely this foal had an impending necrotizing enterocolitis which makes catheter placement even more crucial. While in lateral recumbency the foal aspirated and unfortunately expired due to it. Aspiration was a high risk for this foal from the beginning and every precaution was taken to try to minimize it. The treatment plan for this foal was developed based on published evidence, mindfully constructed and in compliance with the applicable standard of care.
In regard to the mare Sage, despite retained fetal membranes, post operatively she did very well. She was managed on antibiotics, anti-inflammatories and uterine lavages and the retained membranes were recovered without consequence. The Inches’ primary concerns are that the mare was highly distraught over the death of her foal and that she died of incisional failure. As indicated by the medical records, on May 10" around 4pm the mare was sedated for agitation when the deceased foal was taken out, but she quickly settled and remained calm for the remainder of the evening. This was witnessed by myself and 2 additional technicians; she was eating well and standing quietly. The mare was observed normal at 9pm but at 12am she was found deceased in her stall.
Arizona Veterinary Medical Examining Board 1740 West Adams Street, Suite 4600 September 7, 2020
Page 3
Due to the following findings, it is likely that the mare died of an unexpected event unrelated to the surgery such as an aortic rupture, cardiac failure, or stroke:
1. Her incision was monitored carefully post operatively and never showed any signs of compromise. The incision was tight and dry and appeared exactly how it should post operatively.
2. The amount of exposed Gl tract was minimal and not covered in shavings nor macerated. A horse that dies from evisceration is likely to drag around the intestines for potentially hours before shock and death ensue. It is much more likely the incision partially dehisced on impact when she unexpectedly went down due to her large size (she weighed an estimated 1,400 pounds).
3. The stall was not heavily disturbed indicating death was sudden. The state she was found in supports
something abrupt with no struggle.
4. Onamore subjective note, Dr. Justin McCormick has performed over 1,000 abdominal surgeries in the past 5 years without any incisional failure. A statistic that far supersedes most equine surgeons.
A necropsy was offered and encouraged especially due to the unexplainable nature of the death, but was declined by the owners.
On July 27th 2020, Christine reached out to Terris Inches and spoke with her on the phone regarding the letter she had written and her accusations. We expressed that we took their allegations seriously and completed a comprehensive review of the veterinary care provided in this matter. We concluded that none of the veterinary care or services fell below the applicable standard of care. Christine and Copper Ridge Equine expressed their sympathy to the unfortunate outcome and eagerness to work together on a financial plan we were both comfortable with. We expressed to the Inches that we would gladly give our time for free and hope that they could be compassionate to the considerable expense that went into the elective C-section resources and labor. The surgery alone required 3 veterinarians who all gave their time for free and 4 technicians. We repeatedly expressed our sympathies and offered various options with respect to the Inches outstanding bill. Terris Inches called back the following day and declined all of our offers. She made no offer to work together in any fashion.
The Inches brought their mare to Copper Ridge Equine for evaluation of what they reported to be a late term gestation. This mare was not bred by a veterinarian and breeding records were not provided. They were informed of the risks of both giving the mare more time vs cesarian section to remove the fetus. They elected to take the mare to surgery to remove the fetus via cesarian section. Prior to surgery they signed a consent form that they understood the risks and would agree to pay for services..
It is unfortunate that both the mare and foal did not survive. The total invoice was adjusted in compassion with their loss to a reduced total. The Inches have developed a false narrative, in the form of a letter, that suggests the cases were managed with negligence in an effort not to pay their bill. Despite threats to publish these false statements on social media we have attempted to work with them to reconcile their outstanding balance. On August 10" and August 20" the Inches letter was posted on social media. On August 18", the same letter was presented to the Arizona State Veterinary Medical Examination Board requesting investigation into the matter.
Arizona Veterinary Medica! Examining Board 1740 West Adams Street, Suite 4600 September 7, 2020
Page 4
In conclusion, although the outcome of these cases was unfortunate (and honestly emotionally wrecking for us), we do not feel the care was negligent or fell below the standards of veterinary practice.
Sincerely, Christine McCormick, DVM Justin McCormick, DVM, MS, DACVS
1-Paradis Mary. Equine Neonatal Medicine. Elsevier Health Sciences, 2006. 2- Palmer JE Prematurity, dismaturity, postmaturity. Proceedings of the IVECCS V! 1998, p. 722-3.
3- McKenzie III, H. (2007) “How to Provide Nutritional Support of Sick Neonatal Foals”, AAEP Annual Convention - Orlando, 2007.
4- Reed Stephen. Equine Internal Medicine. Saunders; 2nd Edition (December 17, 2003).
5- Buechner-Maxwell, V. (2012) “Practical Approach to Nutritional Support of the Dysphagic Foal”, AAEP Annual Convention - Anaheim, 2012.
VICTORIA WHITMORE - EXECUTIVE DIRECTOR -
DOUGLAS A. DUCEY - GOVERNOR -
ARIZONA STATE VETERINARY MEDICAL EXAMINING BOARD 1740 W. ADAMS STREET, STE. 4600, PHOENIX, ARIZONA 85007 PHONE (602) 364-1-PET (1738) ¢ FAX (602) 364-1039 VETBOARD.AZ.GOV
INVESTIGATIVE COMMITTEE REPORT
TO: Arizona State Veterinary Medical Examining Board
FROM: PM Investigative Committee: Adam Almaraz - Chair Amrit Rai, DVM Cameron Dow, DVM Brian Sidaway, DVM
STAFF PRESENT: Tracy A. Riendeau, CVT — Investigations Marc Harris, Assistant Attorney General
RE: Case: 21-12 Complainant(s}): Sandi and Terris Inches Respondeni(s): Christine McCormick, DVM (License: 6644)
SUMMARY: APPLICABLE STATUTES AND RULES: Complaint Received at Board Office: 8/18/20 Laws as Amended August 2018 Committee Discussion: 12/1/20 (Lime Green); Rules as Revised Board IIR: 1/20/21 September 2013 (Yellow)
On May 8, 2020, "Blue Sage McCue,” a 14-year-old female Warmblood horse was presented to Respondent for evaluation. The horse was past her due date to foal with no signs of parturition. Complainants were given options to either wait or perform an elective cesarean section, along with the risks of both. Complainant chose caesarian section.
Surgery was performed; the foal was post mature but showed signs that he could thrive.
On May 10, 2020, a feeding tube was inserted but the foal continued to decline therefore IV catheter placement was recommended. During the IV catheterization, the foal aspirated and passed away.
Later that evening, the mare was found dead in her stall.
Complainants were noticed and appeared telephonically. Respondent was noticed and appeared telephonically. Attorney David Stoll was present.
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The Committee reviewed medical records, testimony, and other documentation as described below: e Complainant(s) narrative: Sandi and Terris Inches e Respondent(s) narrative/medical record: Christine McCormick, DVM e Consulting Veterinarian(s) narrative/medical records: Alyssa Butler, DVM e Witness(es) Statement(s): Jean Simmons
PROPOSED ‘FINDINGS of FACT’: 1. On April 18, 2019, the horse was bred at Jean Simmons'’s facility by one of her stallions.
2.On May 6, 2020, Dr. Butler was called out to Complainants’ home due to their horse was past her due date to foal. The horse was 383 days in foal and still had minimal udder development. Dr. Butler could feel her foal and could see movement from the exterior left side of her abdomen. When asked about inducing, Dr. Butler explained to them that induction could be risky considering the foals lungs are the last thing to develop and it would have to be done ata hospital. The horse was not in distress at that time. Dr. Butler discussed causes of prolonged gestation with Complainants, including placentitis, thus she dispensed antibiotics. Dr. Butler would be available if the horse had a difficulty delivery.
3. On May 8, 2020, Dr. Butler evaluated the horse — she was bright and alert, eating and acting herself; vitals were normal. Dr. Butler palpated the horse rectally and felt the foal within the birth canal but he had not reached the cervix. Minimal movement of the foal was appreciated. Dr. Butler recommended referral for ultrasound to evaluate the foal. Complainants agreed and hauled the mare to be evaluated by Respondent.
4. Respondent evaluated the mare. It was reported that the mare was 388+ days gestation with no signs of impending parturition. The horse became uncomfortable around 3:00am thus Complainants believed the horse was in labor. Respondent noted no signs of parturition, no signs of abdominal pain, vitals normal, and foal movement of rectal exam. She discussed at length the options of waiting vs an elective cesarean section and the risks of both. Due to the risks of dystocia and adverse effects that increase in severity with each day, Complainants elected cesarean section. Respondent explained that there was likely a problem with the fetus that it is not signaling parturition in the mare and to be prepared for an abnormal or non-viable foal. If the foal was viable, it would likely need intensive care.
5. The surgery was performed that day by Respondent's associate without complication. Respondent stated that post operatively, the foal displayed characteristics of being post mature. Overall, the foal was not normal but did show hopeful signs that he would thrive; he was treated with 24 hour intensive care. The foal was evaluated and noted to have a large frame with thin body condition. Ears were droopy; severe entropion with corneal edema to both eyes that completely obstructed vision; weak suckle reflex; cardiac auscultation was strong and regular; pulmonary auscultation crackles bilaterally; borborgymi adequate in all quadrants; and peripheral pulses strong and synchronous.
6. A liter of plasma was administered |V — the foal was moved to recovery stall with the mare — no attempts to right or stand. Later the foal was moved to the barn with the mare. The foal was intermittently stimulated and encouraged to stand with periods of rest fo allow mare/foal
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bonding. The foal began to stand with assistance — fleet enema administered and meconium passed. Per NGI, the foal was given approximately 150z of colostrum from donor mare and held in standing position for 15 minutes post feeding. Later that evening bucket feeding was attempted — the foal displayed present but weak suckle-swallow reflux — foal interested in mild but did not ingest any or display swallowing. Later the foal did successfully drink approximately 80z of milk from the bucket; stood with assistance.
7. Throughout the night, the foal was drinking milk from the bucket every 2 — 3 hours; 1602, 202, 1202.
8. On May 9, 2020, the foal had a depressed mentation but was responsive (T-96.3; P-72; R-20), hypothermic and weak. Respondent's assessment was post-mature sequalae, congenital brain defect or malformation, metabolic dysregulation, and other. The foal was to be bucket fed 1100z, assistance with standing and walking, stimulate and warm blankets. Additionally the foal was to be administered probiotic paste, nutritional supplement, Omeprazole, metronidazole, eye ointment, Madigan Squeeze, umbilical dip and PCV/TP.
9. Later in the day, it was noted that the foal’s mentation varied between responsive and obtunded. He had vigor to stand and eat was decreasing. Respondent stated that if the foal did not meet the required milk ingestion, tube feedings or indwelling feeding tube would be considered given the foal’s overall clinical impression and absence of signs of feed intolerance.
10. The mare was BAR, eating well, and her incision was dry and tight with no swelling. She was treated with Domperidone, Gentamicin, Penicillin Procaine and Flunixin. Later in the day, the mare was sedated with detomidine, the vulva was aseptically prepped and the uterus was lavaged with sterile saline until effluent clear. No placenta was recovered.
11. On May 10, 2020, Respondent evaluated the foal -— not much change from the previous day. The treatment plan was the same, except the goal for food intake increased to 2200z.
12. The mare was BAR and eating well. The treatment remained the same as the previous day. The horse was again sedated with detomidine for uterine lavage with sterile saline.
13. At 11:00am, NGI feeding was started due to the foal not eating enough on his own. Blood work was also performed and revealed the foal had metabolic acidosis. Due to the foal’s lack of increased vigor since tube feeding in conjunction with the blood work, Respondent decided to place an IV catheter for fluid therapy to support the foal’s cardiovascular system and correct metabolic derangement. If the foal did not respond to IV fluid therapy, a recommendation will be made fo transfer to an internal medicine speciaiist.
14, At 3:00pm, the foal was sedated with butorphanol and diazepam IV and placed in lateral recumbency. Upon aseptic preparation of the jugular vein for catheter placement, milk began to discharge from the foal’s nose. The foal shortly thereafter went into respiratory arrest then cardiac arrest. CPR was immediately initiated but was unsuccessful.
15. The foal was left in the mare’s stall for the mare to acknowledge. When Complainants too the deceased foal, ihe mare began to pace and show signs of agitation. The mare was
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sedated with detomidine which provided relaxation.
16. At midnight, the mare was found dead in her stall; cause unknown. She was last observed at 9:00pm. The abdominal incision was partially dehisced with a small amount of GI tract exposed. A small amount of colon was exposed and not covered in shavings supporting incision dehiscence was not the primary cause of death. Stall bedding did not show signs of being heavily disturbed suggesting abrupt death suck as heart attack or aneurysm. The horse had been doing well therefore the horse’s death was believed to be unrelated. Complainants were notified and necropsy was declined.
17. Complainants expressed concerns that a feeding tube was not placed immediately, that Respondent left the foal during CPR and a portable oxygen tank was not available. Additionally, they felt that cameras should have been in the stall and the fan was not on. Complainants believed the mare passed away due to the sutures failing at the incision site.
18. Respondent explained that stomach tube placement comes with risks and it is not indicated to immediately place an indwelling feeding tube when there is a chance the foal can eat on his own. There is always a risk for aspiration in an ill or maladjusted foal. The head and larynx position when drinking from a bucket, as opposed to a bottle, decreases the risk of aspiration. Allowing the foal to attempt to drink on his own will stimulate increased coordination of swallowing as well as stimulate GI health and mobility in the most natural way possible.
19. Respondent stated that the assistant did bring the portable oxygen tank when the foal arrested. The mare did well post-operatively. There was no indication of being in critical condition or needing intensive care. The mare’s death was unexpected and consistent with an unrelated event and not from the surgery.
COMMITTEE DISCUSSION:
The Committee discussed that this was a difficult and tragic situation. Neo-natal care can be rather dynamic — medically there was a lot of judgment calls made by Respondent and there were no inappropriate medical treatment the Committee could identify.
The NG tube was not placed initially; leaving a NG tube in is not done in these situations due to deficiencies to the nerves in the pharynx area and there is a possibility of causing trauma to the pharynx, as well as risk of infection. An IV catheter was attempted to be placed — due the temperament of foals, this can cause stress and can be traumatic, which is why the foal was sedated. The foal was medically delicate and the risks vs the benefits had to be weighed before attempting any procedure.
The Committee discussed that at times when a person is emotionally distressed and upset, they may not hear or comprehend what is being said. Respondent stated she explained what a necropsy was and why it would be beneficial to help get answers on why the horse died. There were statements by staff stating the horse’s stall was not that disturbed -- what would be considered a mess to one person may be different to another.
Respondent spent much time with Complainants explaining what occurred and were available
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to answer any questions they had. COMMITTEE'S PROPOSED CONCLUSIONS of LAW: The Committee concluded that no violations of the Veterinary Practice Act occurred. COMMITTEE'S RECOMMENDED DISPOSITION:
Motion: It was moved and seconded the Board:
Dismiss this issue with no violation.
Vote: The motion was approved with a vote of 4 to 0.
The information contained in this report was obtained from the case file, which includes the
complaint, the respondent's response, any consulting veterinarian or witness input, and any other sources used to gather information for the investigation.
Tie
Tracy A. Riendeau, CVT Investigative Division
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