| Complaint: | Complaint 21-07 |
|---|---|
| Respondent: | Erica Ou |
| Premises: | Temple Lake Veterinary Clinic |
The complainant says that Ou provided incorrect instructions on insulin administration that cost her dog her life. She says that she was directed to roll rather than shake the insulin contrary to the manufacturer's instructions; she states that her dog went on like this for six weeks having seizures and wasting time. Ou allegedly told them to be very careful to not shake the insulin and commented that the insulin didn't seem to be working. Ou also allegedly dismissed the complainant's husband's concerns about the dog's acute pancreatitis in the context of the diabetes diagnosis; apparently Ou said the acute pancreatitis could be due to an anal gland problem. They eventually got the dog into Salt River Veterinary Specialists and started the dog on human insulin. Unfortunately the dog went into another seizure and was taken to VCA ARECA where the dog died.
Ou gives us a rundown on her exam of the dog and all the problems she found; she notes the big problem was diabetes with secondary pancreatitis, along with some electrolyte imbalances because the dog was so sick. Ou said that once the dog was eating and drinking again she wanted to start the dog on insulin. This was done at the veterinary clinic so she could watch the dog's glucose levels; the dog's levels during the glucose curve ranged from 443 mg/dL to 285 mg/dL and the dog was sent home with instructions. The dog came back allegedly not eating but ate in the clinic; another in-hospital treatment was done with glucose from 428 mg/dL to 232 mg/dL. Based on the results Ou concluded the dog was doing fine on the insulin but perhaps something was going wrong at home and adjusted the dosage. The dog later showed up again with blood glcuose at home from 623 mg/dL to 511 mg/dL. Ou recommended the dog go to an internal medicine specialist because she suspected some other underlying disease such as Cushing's, infectious disease, cancer, or other problems. They also switched to a new bottle of Vetsulin; according to Ou, the dog was said to do well on this until the dog ended up at an emergency clinic. The complainant allegedly reported that the dog's blood glucose at the seizure was 90 mg/dL and had concerns for hypoglycemia; the complainant also raised her concern about rolling instead of shaking the insulin and Ou referred her to whatever the vets at Salt River told her to do. The dog eventually ended up with diabetic ketoacidosis and died at VCA ARECA. Ou says she did some research and contacted Merck's internal medicine specialists and they told her that there was no difference between rolling and shaking the insulin as long as it's uniformely mixed. She says that she can confidently guarantee that the mixing of the insulin had nothing to do with the dog's death as she's looked into it herself. (It's really quite the read, and you should read it in conjunction with the VIN article she references and cited below.)
The Investigative Committee said that it's too bad they didn't get information from the complainant about how the insulin was being given at home as they felt that Ou was getting some good glucose curves at the hospital. They didn't feel there was a violation. Perhaps they felt it more likely that the complainant, a licensed pharmacist, was ignorant or incapable of understanding how to handle insulin.
The amazing thing is that this appears to have been a big question mark in the veterinary community for years (see "Vetsulin back with label changes" by Edie Lau in a 2013 VIN article which Ou cites). Vetsulin was pulled from the market due to stability concerns but brought back without any changes to formulation; rather, as a spokesperson stated in the mentioned article, it's more like making cookies where you just need to be more careful with your ingredients! They also made changes to the drug's label, but not the drug. The biggest change, and one that sent veterinarian-only VIN message boards into a tizzy, was that they were being told to shake the insulin rather than roll it around. Veterinarians were concerned based on advice about other insulin that shaking it tended to destroy the molecules, whereas the Vetsulin people said that you needed to shake it good because it had a tendency to separate out and not mix back together. Between Ou's alleged conversation and the VIN article we're supposed to somehow believe that it doesn't matter as long as it's mixed, but it's really hard to mix without shaking it, and that deep down nobody really knows anyway. None of it would necessarily inspire confidence in a dispassionate observer.
| Source: | December 12, 2020 AM Investigative Committee Meeting |
|---|---|
| People: | |
| David Stoll | Respondent Attorney |
| Erica Ou | Respondent |
| Roll Call: | |
| Carolyn Ratajack | Aye |
| Christina Tran | Absent |
| Jarrod Butler | Aye |
| Robert Kritsberg | Aye |
| Steve Seiler | Aye |
| Result: | Passed |
| Source: | February 2, 2021 Board Meeting |
|---|---|
| People: | |
| David Stoll | Respondent Attorney |
| Proposed By: | Nikki Frost |
| Seconded By: | Sarah Heinrich |
| Roll Call: | |
| Darren Wright | Aye |
| J Greg Byrne | Absent |
| Jane Soloman | Aye |
| Jessica Creager | Aye |
| Jim Loughead | Aye |
| Nikki Frost | Aye |
| Robyn Jaynes | Aye |
| Sarah Heinrich | Aye |
| 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.