Doctor Reed's Double Feature: He's accused of paralyzing a dog during an exam

Complaint: Complaint 18-57
Respondent: Refaat Ishak
Premises: St Mark Animal Hospital

The complainant had been taking his dog to Ishak for about a year. The complainant says Ishak diagnosed an infection and prescribed medicine. The dog started having blood in the stool and rectal bleeding, and Ishak said it was the medicine. Subsequent follow-up was said to have resulted in a diagnosis of a kidney stone, and that after another visit to draw blood and urine the dog was returned unable to stand on her hind legs. The complainant decided against further treatment and had the dog euthanized.

Ishak confirms most of the events and states that he diagnosed the kidney stone and recommended a referral, also sending out labs. He also says that the complainant had agreed to ultrasound before choosing euthanasia. Ishak also says that he attempted to talk the complainant out of euthanasia as he felt the dog could be saved and that the conditions could be managed according to the lab work but was unsuccessful.

The Investigative Committee found several violations and felt that Ishak's exam could have caused the dog's inability to walk, stating that an (unnamed and unavailable) witness statement also confirms the dog can no longer walk. The veterinary board concurred with the violation.

Guess what? This complaint, 18-57, was received at the veterinary board on January 26, 2018. The last complaint, 18-56, was received on January 25, 2018, and is about Ishak as well. What are the odds?

Motions

Investigative Motion: Find violation

Source: April 4, 2018 PM Investigative Committee Meeting
People:
Refaat Ishak Respondent
Roll Call:
Adam Almaraz Aye
Amrit Rai Aye
Christine Butkiewicz Aye
Donald Noah Aye
Tamara Murphy Aye
Violations:
ARS 32-2232 (12) as it relates to AAC R3-11-501 (1) failure to provide professionally acceptable procedures for not recognizing the dog's paresis on discharge on December 21, 2017 and again on December 22, 2017 when dropped off for euthanasia; medical records state the dog was ambulatory
ARS 32-2232 (12) as it relates to AAC R3-11-501 (8) failure to provide copies of medical records within 10 days of the pet owners request
ARS 32-2232 (21) as itrelates to AAC R3-11-502 (F) failure to obtain signed authorization from the pet owner before euthanasia was performed.
Result: Passed

Board Motion: Schedule informal interview

Source: April 4, 2018 Board Meeting
Proposed By: Darren Wright
Seconded By: Jessica Creager
Roll Call:
Christina Bertch-Mumaw Aye
Darren Wright Aye
J Greg Byrne Aye
Jessica Creager Aye
Jim Loughead Aye
Julie Young Aye
Nikki Frost Absent
Robyn Jaynes Aye
Sarah Heinrich Aye
Result: Passed

Board Motion: Remand to formal hearing

Source: June 6, 2018 Board Meeting
People:
Artie Eaves Respondent Attorney
David Stoll Respondent Attorney
Larry Cohen Respondent Attorney
Refaat Ishak Respondent
Proposed By: Sarah Heinrich
Seconded By: Darren Wright
Roll Call:
Christina Bertch-Mumaw Absent
Darren Wright Aye
J Greg Byrne Absent
Jessica Creager Aye
Jim Loughead Aye
Julie Young Aye
Nikki Frost Aye
Robyn Jaynes Aye
Sarah Heinrich Aye
Result: Passed

Board Motion: Accept consent agreement

Source: December 12, 2018 Board Meeting
People:
David Stoll Respondent Attorney
Larry Cohen Respondent Attorney
Proposed By: Darren Wright
Seconded By: Christina Bertch-Mumaw
Roll Call:
Christina Bertch-Mumaw Aye
Darren Wright Aye
J Greg Byrne Aye
Jane Soloman Aye
Jessica Creager Aye
Jim Loughead Aye
Nikki Frost Aye
Robyn Jaynes Absent
Sarah Heinrich Aye
Result: Passed

Board Order: Order 18026 REFAAT ISHAK, DVM

Source: Order 18026 (December 12, 2018)
Violations:
A.R.S. § 32-2232(22) Medical Incompetence in the practice of veterinary medicine for performing. diagnostics without medical justification indicating that Respondent lacked sufficient knowledge; inappropriate use of hydromorphone for pain control where the method of administration left large windows of pain present; and pain medication was not dispensed at discharge in or around August 21, 2017.
A.R.S. § 32-2232(18) for Violating the Board’s Order in Case Nos. 15-77 and 15-103 by extracting teeth and/or performing surgery during two anesthetic procedures involving a dog and a cat on December 18, 2017, and December 29, 2017, respectively, where the Board’s Order restricted Respondent from performing any and all surgeries indefinitely including soft tissue, orthopedic, and oral surgeries, including dental extractions.
A.R.S. § 32-2232(12) as it relates to A.A.C. R3-11-501(1) for failure to provide professionally acceptable procedures for not recognizing the dog's paresis on discharge on December 21, 2017, and again on December 22, 2017, when dropped off for euthanasia where medical records stated dog was ambulatory
A.R.S. § 32-2232(12) as it relates to A.A.C. R3-11-501(8) for failing to provide copies of medical records within 10 days of the pet owners request
A.R.S. § 32-2232(21) as it relatesto A.A.C. R3-11-502(F) for failure to obtain signed authorization from the pet owner before euthanasia was performed
A.R.S, § 32-2232 (11} Gross incompetence; A.R.S. § 32-2232 (12) as it relates to R3-11-501 (3);
A.R.S. § 32-2232 (22) Medical incompetence in the practice of veterinary medicine; and administrative violation of A.R.S. §°32-2233 (B) (3).
A.R.S. § 32-2232 (11) Malpractice, gross negligence and gross incompetence
A.R.S. § 32-2232 (22) Medical incompetence in the practice of veterinary medicine.
Penalties:
Respondent is prohibited from performing any veterinary services with the exception of the following: Euthanasia procedures that are not based upon his diagnosis but rather on a diagnosis made by another veterinarian or at an owner's request;
Respondent is prohibited from performing any veterinary services with the exception of the following: Pre-vaccination examinations; vaccinations; blood draws related to heartworm, FIV/FeLV tests and other Snap tests that are performed in-house; microchipping; nail -trims; anal gland expressions; and providing/dispensing heartworm preventive care if appropriate testing had occurred and/or medical records from another provider indicate the medication is appropriate.
Respondent is prohibited from performing any veterinary services with the exception of the following: Write prescriptions and/or dispense heart worm prevention and flea and tick control medications and may send out fecal exam tests fo external labs, with the understanding that the owner must be instructed to follow up with their regular veterinarian in connection with any abnormal findings or results.
Respondent must refer clients to another licensed veterinarian if resulis from anytests are posilive/abnormal.
These practice restrictions shall remain in place for a minimum of ten (10) years. Respondent may petition the Board for modification annually.
Respondent is prohibited from performing any veterinary services beyond those authorized under this Consent Agreement.

Board Order: Order 18056 REFAAT ISHAK, DVM

Source: Order 18056 (December 12, 2018)
Violations:
A.R.S. § 32-2232(22) Medical Incompetence in the practice of veterinary medicine for performing. diagnostics without medical justification indicating that Respondent lacked sufficient knowledge; inappropriate use of hydromorphone for pain control where the method of administration left large windows of pain present; and pain medication was not dispensed at discharge in or around August 21, 2017.
A.R.S. § 32-2232(18) for Violating the Board’s Order in Case Nos. 15-77 and 15-103 by extracting teeth and/or performing surgery during two anesthetic procedures involving a dog and a cat on December 18, 2017, and December 29, 2017, respectively, where the Board’s Order restricted Respondent from performing any and all surgeries indefinitely including soft tissue, orthopedic, and oral surgeries, including dental extractions.
A.R.S. § 32-2232(12) as it relates to A.A.C. R3-11-501(1) for failure to provide professionally acceptable procedures for not recognizing the dog's paresis on discharge on December 21, 2017, and again on December 22, 2017, when dropped off for euthanasia where medical records stated dog was ambulatory
A.R.S. § 32-2232(12) as it relates to A.A.C. R3-11-501(8) for failing to provide copies of medical records within 10 days of the pet owners request
A.R.S. § 32-2232(21) as it relatesto A.A.C. R3-11-502(F) for failure to obtain signed authorization from the pet owner before euthanasia was performed
A.R.S, § 32-2232 (11} Gross incompetence; A.R.S. § 32-2232 (12) as it relates to R3-11-501 (3);
A.R.S. § 32-2232 (22) Medical incompetence in the practice of veterinary medicine; and administrative violation of A.R.S. §°32-2233 (B) (3).
A.R.S. § 32-2232 (11) Malpractice, gross negligence and gross incompetence
A.R.S. § 32-2232 (22) Medical incompetence in the practice of veterinary medicine.
Penalties:
Respondent is prohibited from performing any veterinary services with the exception of the following: Euthanasia procedures that are not based upon his diagnosis but rather on a diagnosis made by another veterinarian or at an owner's request;
Respondent is prohibited from performing any veterinary services with the exception of the following: Pre-vaccination examinations; vaccinations; blood draws related to heartworm, FIV/FeLV tests and other Snap tests that are performed in-house; microchipping; nail -trims; anal gland expressions; and providing/dispensing heartworm preventive care if appropriate testing had occurred and/or medical records from another provider indicate the medication is appropriate.
Respondent is prohibited from performing any veterinary services with the exception of the following: Write prescriptions and/or dispense heart worm prevention and flea and tick control medications and may send out fecal exam tests fo external labs, with the understanding that the owner must be instructed to follow up with their regular veterinarian in connection with any abnormal findings or results.
Respondent must refer clients to another licensed veterinarian if resulis from anytests are posilive/abnormal.
These practice restrictions shall remain in place for a minimum of ten (10) years. Respondent may petition the Board for modification annually.
Respondent is prohibited from performing any veterinary services beyond those authorized under this Consent Agreement.

Board Order: Order 18057 REFAAT ISHAK, DVM

Source: Order 18057 (December 12, 2018)
Violations:
A.R.S. § 32-2232(22) Medical Incompetence in the practice of veterinary medicine for performing. diagnostics without medical justification indicating that Respondent lacked sufficient knowledge; inappropriate use of hydromorphone for pain control where the method of administration left large windows of pain present; and pain medication was not dispensed at discharge in or around August 21, 2017.
A.R.S. § 32-2232(18) for Violating the Board’s Order in Case Nos. 15-77 and 15-103 by extracting teeth and/or performing surgery during two anesthetic procedures involving a dog and a cat on December 18, 2017, and December 29, 2017, respectively, where the Board’s Order restricted Respondent from performing any and all surgeries indefinitely including soft tissue, orthopedic, and oral surgeries, including dental extractions.
A.R.S. § 32-2232(12) as it relates to A.A.C. R3-11-501(1) for failure to provide professionally acceptable procedures for not recognizing the dog's paresis on discharge on December 21, 2017, and again on December 22, 2017, when dropped off for euthanasia where medical records stated dog was ambulatory
A.R.S. § 32-2232(12) as it relates to A.A.C. R3-11-501(8) for failing to provide copies of medical records within 10 days of the pet owners request
A.R.S. § 32-2232(21) as it relatesto A.A.C. R3-11-502(F) for failure to obtain signed authorization from the pet owner before euthanasia was performed
A.R.S, § 32-2232 (11} Gross incompetence; A.R.S. § 32-2232 (12) as it relates to R3-11-501 (3);
A.R.S. § 32-2232 (22) Medical incompetence in the practice of veterinary medicine; and administrative violation of A.R.S. §°32-2233 (B) (3).
A.R.S. § 32-2232 (11) Malpractice, gross negligence and gross incompetence
A.R.S. § 32-2232 (22) Medical incompetence in the practice of veterinary medicine.
Penalties:
Respondent is prohibited from performing any veterinary services with the exception of the following: Euthanasia procedures that are not based upon his diagnosis but rather on a diagnosis made by another veterinarian or at an owner's request;
Respondent is prohibited from performing any veterinary services with the exception of the following: Pre-vaccination examinations; vaccinations; blood draws related to heartworm, FIV/FeLV tests and other Snap tests that are performed in-house; microchipping; nail -trims; anal gland expressions; and providing/dispensing heartworm preventive care if appropriate testing had occurred and/or medical records from another provider indicate the medication is appropriate.
Respondent is prohibited from performing any veterinary services with the exception of the following: Write prescriptions and/or dispense heart worm prevention and flea and tick control medications and may send out fecal exam tests fo external labs, with the understanding that the owner must be instructed to follow up with their regular veterinarian in connection with any abnormal findings or results.
Respondent must refer clients to another licensed veterinarian if resulis from anytests are posilive/abnormal.
These practice restrictions shall remain in place for a minimum of ten (10) years. Respondent may petition the Board for modification annually.
Respondent is prohibited from performing any veterinary services beyond those authorized under this Consent Agreement.

The primary source for the above summary was obtained as a public record from the Arizona State Veterinary Medical Examining Board. You are welcome to review the original records and board meeting minutes by clicking the relevant links. While we endeavor to provide an accurate summary of the complaint, response, investigative reports and board actions, we encourage you to review the primary sources and come to your own conclusions. In some cases we have also been able to reach out to individuals with knowledge of specific complaints, and where possible that information will be included here.