| Complaint: | Complaint 19-32 |
|---|---|
| Respondent: | Clemence Chako |
| Premises: | Midwestern University |
The complainant and her husband discovered that their alpaca was suffering from heat stress. (Alpacas are native to mountainous regions of South America and have a bad habit of overheating and dropping dead in places like the deserts of the US Southwest.) They tried everything including electrolyte enemas, evaporative coolers, and lots of fans, but the alpaca didn't improve. They phoned Midwestern University and Chako showed up for an alpaca house call. His exam found extensive muscle damage, edema, and heat stress and recommended lifting the alpaca up and keeping it cool. The next day the alpaca was moving her legs and able to eat, drink, and breathe normally. The complainant was told that for every day the alpaca was down the likelihood of recovery decreased by 25% and that if the alpaca didn't recover in the next few days euthanasia would be required. The complainant was worried about the edema and asked about Lasix. Chako recommended hetastarch because, according to the complainant, he told her it "stops fluid leakage." Chako and another person came out to administer the hetastarch and the complainant said that the alpaca started to do worse just during the IV. About twenty minutes in the alpaca started having significant trouble breathing and gasping, at which point Chako stopped the IV and administered other drugs. The alpaca also started to bloat so they put in a tube. She asked Chako what to do and he allegedly told her to only feed the alpaca grain for 24 hours; when she pressed him on the issue, he allegedly changed his mind to suggest hay in a bucket of water, then left. The alpaca's edema progressed "to the point that her thighs felt like Play Doh and her vulva and anus were protruding out she was so swollen." The next morning the alpaca was tired and gasping for breath, and she died with a clear fluid pouring out of her mouth. The complainant cites various sources about hetastarch and notes concerns about using it in a hypervolemic animal instead of a hypovolemic one. She also notes a variety of hypersensitivity reactions and side effects.
Chako's response was written by Midwestern University's lawyer, Barbara McCloud. She begins by telling us about Midwestern University and then a bit about Chako, all of which reads like a website bio or sales pitch. We learn that he's treated dozens of alpacas in his four years of postgraduate clinical training and treated at least 12 alpacas in the past year alone. The response goes into some of the same events as the complainant mentions, although written from the other point of view. We do learn that when Chako returned for the recheck the other person was Matthew Cuneo, another veterinary professor at Midwestern University. we also get an explanation as to why Chako viewed Lasix as the incorrect treatment, and we're also told that he has often used Hetastarch as a treatment for heat stress in alpacas. McCloud points out that the complainant's concerns about off-label use of hetastarch isn't a big deal because they use off-label stuff in veterinary medicine all the time. They also use hetastarch all the time. She also says that Chako reported the animal's death to Midwestern's Quality Assurance Committee, who prepared a report saying that Chako acted appropriately. Chako signs below McCloud stating that he agrees with what McCloud wrote up.
The Investigative Committee said that use of a colloid (hetastarch) was appropriate and that the alpaca had a poor prognosis. It's interesting because when you look up hetastarch you'll learn a lot about it, even more than what the complainant mentioned. One thing you will learn is that much of the positive press about hetastarch use in humans was the result of academic fraud (look up Joachim Boldt), itself a scandal. You'll also learn the FDA and the European Medicines Agency started stamping black-box warnings on it as early as 2013, and at this point recommend not using it at all if you have other options. Note a 2013 VIN article ("Veterinarians concerned about FDA’s hydroxyethyl starch warning") in which veterinarians wonder if it's a problem in their profession and come to the conclusion that nobody knows; the FDA says they can't comment because they never said it was okay in other animals in the first place.
Another fun fact: Donald Noah recused himself on this one. Turns out he was also associated with Midwestern University's College of Veterinary Medicine and held several high-profile jobs there (depending on which source you read).
| Source: | February 2, 2019 PM Investigative Committee Meeting |
|---|---|
| People: | |
| Barbara McCloud | Respondent Attorney |
| Clemence Chako | Respondent |
| Roll Call: | |
| Adam Almaraz | Aye |
| Amrit Rai | Aye |
| Christine Butkiewicz | Aye |
| Donald Noah | Recused |
| William Hamilton | Aye |
| Result: | Passed |
| Source: | April 4, 2019 Board Meeting |
|---|---|
| Proposed By: | J Greg Byrne |
| 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 | Absent |
| Result: | Passed |
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.