| Complaint: | Complaint 21-09 |
|---|---|
| Respondent: | Omar Gonzalez-Citron |
| Premises: | Midwestern University |
| Related: | 21-10 |
The complainant had been taking pets to Bennett, a veterinarian, since 1991; Bennett started working as faculty at Midwestern (when vet schools start, at least in Arizona, they tend to drive around town hiring local veterinarians as faculty, but that's a different story). Her cat started having some problems after a move; this was apparently chalked up to stress and later to allergies. Subsequent evaluation found nothing so a cardiologist at Midwestern (perhaps prominent mobile cardiologist Christopher Paige) did x-rays and ultrasounds; she was told the cat's heart had no problems and there was a small amount of fluid that would likely be reabsorbed. She continued to watch the cat for ill effects and aside from a fall the cat had no major medical problems. A month after the fall the cat started having elevated breathing rates and a blue tongue. Midwestern was closed but a recording told the complainant to take the cat to 1st Pet; 1st Pet performed a fast scan, a thoracocentesis, and suspected the cat had thymus cancer, but said they didn't have the equipment to do any further diagnostics. The complainant's cat was then sent to VetMed where another cardiologist, Miller, did another ultrasound and thoracocentesis. The cat went back to Midwestern for even more ultrasounds and thoracocentesis procedures. The cat even saw Radlinsky, a boarded surgeon formerly of VetMed, at Southwest Veterinary Specialists, who said that a CT scan was needed before surgery could be performed. The cat had a CT scan at Midwestern that identified a pleural thickening and a "tiny mineral tubular foreign body of 0.2 inches in diameter." The cat went back to VetMed for another thoracocentesis before being cut on by Gonzalez back at Midwestern.
The complainant appears to have met Gonzalez for the first time on the same day as the surgery. According to her, Gonzalez said that the cat's fall had nothing to do with any of these problems and that he thought the foreign object on the CT scan was the cause; he allegedly told her that she was actually very lucky because most cases of chylothorax have no known cause. Gonzales also allegedly said that he didn't recommend thoracic duct surgery because of the foreign body but did suggest removing the heart sac, which made the complainant uncomfortable; he said it would have to come out anyway. He also said that it would help in the event future surgeries were needed. He said he could do the surgery today but didn't know about future availability; he also told her that she would have to take the cat to VetMed for 24-hour care because the school had minimal staff as a result of the coronavirus shutdown. The complainant was still concerned but Gonzales told her that he had an 80% success rate (higher even than the 50% Radlinsky had allegedly quoted her just a week prior), and another veterinarian, Lavin, was also there and said this was all cool. The complainant refers to the cat as her baby boy and says she waited in the parking lot with her roommate for the cat to be discharged and taken to VetMed. She received a call from Gonzalez saying that the surgery went well but the foreign object had disappeared or dissolved somewhere. Gonzalez took a biopsy of a darker area in the chest near where the foreign object was thought to be; we're told this later came back as chronic inflammation.
The complainant took her cat to VetMed as directed. She says that she couldn't get anyone at VetMed to talk to her so she kept trying to get through to Gonzalez. At length the other vet, Lavin, called her from Midwestern and said Gonzalez was working from home for the next three weeks because of "child care issues." VetMed apparently started telling the complainant that the cat wasn't doing well and the surgery didn't pan out as the cat wasn't eating and had "tons of fluid"; Gonzalez had apparently said the cat would likely heal in a couple of days, no more than four, and the cat had now been hospitalized for four days. She finally emailed Bennett at Midwestern and Gonzalez got back to the complainant; he said that VetMed had caused the problem as they didn't take the drain out. He called VetMed who then apparently took out a drain and sent the cat home. The cat kept swelling up with fluid and had to be tapped every few days at Midwestern; apparently Midwestern's emergency service finally bailed and sent the cat back to VetMed. Gonzalez basically disappeared at this point; the complainant says she never heard from the guy again and Lavin handled all communications, saying she would let him know. Meanwhile her cat was getting worse and she kept getting shuffled from surgeon to surgeon. She says that she was also getting different stories about the foreign object; Gonzalez and Lavin allegedly told her that it had dissolved whereas Maki allegedly told her it was misrepresented in the scan.
Shaver, a surgeon at Midwestern, saw the cat to remove stitches and recommeneded a thoracic duct ligation; at this point the cat had swelling all over his body and Shaver allegedly had no idea as to the cause. Shaver allegedly said that she had a 0% success rate doing the surgery and had only done them twice before; she also apparently wanted to do this without the methylene blue dye that other surgeons had said would be required. (The complainant says that a later examination of the records tells us Shaver said no foreign object was removed during the surgery, so she wonders if Shaver is looking for a reason to go in and get it.) She felt that she was being lied to and could not get answers directly from Gonzalez; she was being told her cat had some other phantom internal medicine issue yet Midwestern kept delaying getting her into internal medicine there. She finally went back to VetMed where they allegedly found something on ultrasound in the same general area that the foreign object was.
Bennett referred the complainant to Angela Mexas at Desert Veterinary Medical Specialists. (Mexas, interestingly, was also an internal medicine specialist at Midwestern at some point and co-authored a research paper on pain control in rats used in scientific experiments. see "Inappropriate Post-Operative Analgesia is Achieved Using Recommended Doses of Sustained-Release Meloxicam in Mice" for those interested in self-guided continuing education). Mexas apparently had a second CT scan done that found the cat now had a borken xiphoid bone (breastbone) and a round metallic object in the chest that wasn't mentioned. She attempted to speak with Gonzalez and at one point was allegedly contacted by Mexas. Gonzalez finally spoke with the complainant again. He said that he didn't leave anything behind in surgery and that whatever the second CT scan was showing was the same object as the first one. He is also claimed to have said that he didn't notice a broken xiphoid bone during surgery but conceded that it could have happened as a consequence of the surgery. He also allegedly said that the foreign object near the heart was concerning and would speak to the administration about a second surgery. The complainant pointed out that her cat was doing very badly and was swelling everywhere and covered in bruises; she wanted to avoid students handling the cat, but was told by Bennett that students must be involved in care at all times because students take priority over pets. (She also wonders if Lavin, the student, was involved in assisting Gonzalez and may have botched the surgery; she says that she had a problem where a radical mastectomy went poorly when a student veterinarian was involved and has always had concerns since.)
The complainant made an appointment with VetMed instead but the cat died horribly at home before the appointment could take place. She said it was the most horrible experience she has ever seen including the death of other pets and she cries over the images in her mind every day. She tried to have VetMed perform a necropsy but they told her they send all the necropsies to Midwestern. She called Canyon State Veterinary Specialties who also outsource all necropsies to Midwestern. She had the necropsy performed and discussed the result with Bennett. She asked Bennett for the foreign object removed from the cat's body; Bennett told her that the pathologist recommended against giving it to her. She later received an email from Bennett saying that the foreign object had been cremated with the cat; the necropsy report allegedly said that the objects had been saved at the complainant's requested. Bennett eventually made arrangements to give her an object that was supposed to be the (allegedly cremated) object in question; the complainant says that it doesn't match the description of the "hard, 4mm in diameter, spherical nodule" mentioned in the necropsy report. She also says that she experienced issues getting her cat's full medical records; she was told that the request had to be delayed until Gonzalez approved the release. She concludes by stating that she believes she was lied to and that Midwestern (and Gonzalez) let her cat suffer for months needlessly; she also says that she has to live with the pain of trusting any of them and that she spent $18000 to get her son killed.
Midwestern's response, as with other Midwestern complaints, begins with a long letter from Barbara McCloud, their attorney. She tells us that in addition to Omar Gonzalez and Patricia Bennett, many other veterinarians were involved in the cat's care: Stephanie Shaver, Stephanize Szabo, Darius Starks, Lynn Maki, Kara McArdell, Hailey Turner, David Sender, and Lindsey Lavin. McArdell, Turner, and Sender were faculty who have all since left; Lavin was a surgical resident on a one-year appointment. McCloud's response also begins with a general timeline that tends to match the complainant's, but then begins to diverge; she attempts to paint the complainant as in denial of her cat's poor health, stating that she made comments about "negative energy" being out there and routinely turning down treatment recommendations. We're also told that discussions were made about the complainant's financial limitations in pursuing treatment (yet the complainant herself says this cat was her son and she spent $18000 to try and save him); McArdell and Starks are listed in these statements in particular. We're then told that Gonzalez did the surgery but that no doctors would be in the hospital overnight as a result of coronavirus restrictions (in my own conversations with Shaver about my own dog in 2018, she said there were no doctors overnight, and that was prior to COVID). We're also told that the complainant kept bringing the cat back to see a variety of people at Midwestern; Shaver said that the cat would likely never be normal and recommended an additional surgery, whereas other veterinarians said the symptoms were not unexpected or severe, and yet others seem to say that the complainant wasn't following directions on how to take care of the cat. McCloud concludes that everyone tried their best for the cat but that the complainant kept making up her diagnoses. To McCloud, the fate of the cat rests with the complainant and not Midwestern; she also says Gonzalez shouldn't be punished because the complainant can't accept the death of her cat.
Gonzalez' own response says that he was first brought into the case when Bennett said the cat needed an emergency consult; Rachel Kinkade, the scheduling coordinator, set up Gonzalez to see the complainant. Lavin, a surgical resident, admitted the cat to the hospital as no owners were permitted inside because of the coronavirus. He says that he examined the cat and found the cat to be overall the same as previous examinations; he went on to discuss surgery. He says that while Radlinsky quoted a 50% chance of success a more recent paper suggests the rate of success is actually closer to 80% in a study of 22 cats; he also said that the foreign body may not be able to be removed and that the cat may actually only have a 50% chance of actually getting any better. He says that the complainant kept having doubts about the surgery but he was able to convince her that it was needed. He also tells us that as Midwestern had no overnight veterinarians because of the coronavirus (actually, I spoke with Shaver about my own dog in 2018 and was told they had no overnight veterinarians there either; she told me to my face that Midwestern wasn't really set up to do an adrenalectomy, which is also a rather risky procedure). He says that the cat was discharged to VetMed and that he was away from work because of personal issues soon after. His boss, Mark Acierno, contacted him as the complainant was upset about the cat's condition at VetMed; according to Gonzalez, the tube was left in because of the complainant's wishes and this made the matter worse. He also says that cat was brought back for checkups and possible surgery and seen by several other veterinarians at Midwestern. He also had a phone call with Mexas, the internal medicine specialist with Midwestern University ties, who asked if he used metal sutures that could explain the metal object found on CT scan; he claims he told her that it was most likely the same object that was in there before the first surgery. He also says that the broken xiphoid bone could have been the result of a rib spreader he used during surgery but that even if so, in most cases a broken xiphoid bone doesn't hurt anybody. He also says he followed up with the radiologist, Sasha Naugler, about the CT scan and attempted to convince her that the new object was the same as the old object and just a misinterpretation; he relates that Naugler wasn't so sure. Gonzalez, just like McCloud, says that the complainant has made up a story that ignores the facts; he also accuses her of ignoring the severity of the cat's condition.
The Investigative Committee said that Lavin wasn't involved with the actual surgery, she just watched and helped out, just like Szabo the faculty member. They also said that the object on the first CT scan was the same as the object on the second CT scan (apparently Rai and Dow, neither of whom are radiologists of any kind, are more qualified to make that determination than the radiologists who did the second CT scan and apparently didn't buy what Gonzalez was selling). They also say that the complainant got a lot of different advice and a lot of different diagnoses about the cat but that she "fixated" on the foreign body (in fairness, she says that she was told the foreign body was the root cause and needed to come out). They also said that if 80% of the procedures succeed then 20% of them fail (Gonzalez apparently quoted 80% from a study of 22 cats, not his own statistics, and he also says in his response that there was at best a 50% chance of the cat doing better even if he cut).
Brian Sidaway, founding dean of Midwestern University's veterinary program, is on this Committee, but he was absent that day. During his interview with the Board, he basically claimed credit for getting the entirety of their program off the ground.
For a tale very similar to this one about a dog, Titus, at Midwestern and his heartbroken family, see 19-19 and the four subsequent complaints. For a story where an alpaca keels over after being given a colloid all but withdrawn from human use over safety concerns, see 19-32.
| Source: | December 12, 2020 PM Investigative Committee Meeting |
|---|---|
| People: | |
| Barbara McCloud | Respondent Attorney |
| Omar Gonzalez-Citron | Respondent |
| Roll Call: | |
| Adam Almaraz | Aye |
| Amrit Rai | Aye |
| Brian Sidaway | Absent |
| Cameron Dow | Aye |
| Result: | Passed |
| Source: | February 2, 2021 Board Meeting |
|---|---|
| People: | |
| Barbara McCloud | Respondent Attorney |
| Omar Gonzalez-Cintron | Respondent |
| Proposed By: | Sarah Heinrich |
| Seconded By: | Jessica Creager |
| 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.