| Complaint: | Complaint 21-121 |
|---|---|
| Respondent: | Dylan Rubalcaba |
| Premises: | AZPetVet Dobson Ranch Animal Hospital and Grooming |
The complainants say their cat was being treated by Hirth to take care of a respiratory problem but was otherwise healthy. It was time for dental surgery that was handled by Rubalcaba; he allegedly said that the cat was healthy enough for a dental. The complainant says that he lied several times during their interactions, including what teeth were being pulled and when. The complainants also relate that the cat took four hours to come out of anesthesia and Rubalcaba took off for home before the cat had recovered; he left the cat with staff. They say that in a call the following day (not included in the records they received) Rubalcaba admitted that the cat should have been taken to emergency at VCA. They can't believe Rubalcaba pulled 23 teeth in one operation rather than staging it, then took off for home and left the cat with staff when the cat was still coming out of anesthesia; they say that Hirth told them Rubalcaba was inexperienced but they say this goes beyond inexperience. There's also a comment about the autopsy and "protecting vets," stating that it's hard to imagine that a healthy cat with a runny nose comes out with acute problems and dies. (The Findings of Fact state that the cat had moderate to severe chronic hypertrophic cardiomyopathy along with significant acute pulmonary congestion and edema.)
Rubalcaba says they were going to take out the teeth to help with stomatitis. He says the cat had some mild upper respiratory congestion but was otherwise in good shape; blood work came back good. They went ahead and did the dental; he relates that he told the complainant the cat's quality of life would be a lot better once this dental was over! He says that the dental went okay but the cat had a very slow recovery; there were also increased respiratory sounds that made him suspicious for aspiration pneumonia. They ran x-rays but found nothing; they pushed the discharge time back to 6:00 but the lungs appeared clear. He wanted the cat rechecked first thing in the morning but the cat didn't make it until then. He says the complainant was very angry and rude when he checked out with the cat and used mean, profane, nasty language. The cat died overnight so they arranged a necropsy with Richard Hoffman at Veterinary Pathology Services; he chalked it up to a "sudden death appears associated with this underlying and likely subclinical feline cardiomyopathy." (Did Dobson Ranch pick Veterinary Pathology Services? Veterinary Pathology Services' site says they also do histopathology and cytology work in addition to necropsies, so how many ties does it have with Dobson Ranch? What about the rest of AZPetVet, of which Dobson Ranch is just one clinic?)
The Investigative Committee basically phones it in yet again in this one. They state that the cat definitely had hypertrophic cardiomyopathy which "is a silent killer in cats and cannot be detected." They also said that once the cat has "clinical signs, there is nothing that can be done" and that the anesthesia alone might have been enough to cause it to break loose and kill the cat. Some Committee members allegedly felt that Rubalcaba should have stuck around or made better plans, but they also said it wasn't really fair to judge him; he did think about sending the cat to an emergency facility before he decided not to, and he also trusted his staff. The official Findings of Fact instead state that the complainant was a "difficult client" and "routinely unprofessional."
Dow, Rai, and Sidaway say that this cat was basically doomed because of the heart condition. Cornell, on the other hand, says otherwise: "While the disease’s effects and prognosis (predicted outcome) may vary considerably, proper diagnosis and treatment can decrease the chance that a cat with HCM will experience certain symptoms and can improve his or her quality of life" (link). The Cornell writeup also suggests that the condition is diagnosed via echocardiography; admittedly that's not a standard part of the preanesthetic workup. Some sources also suggest that in severe situations an x-ray might have detetected the heart enlargement if not the exact cause; the Findings of Fact describe it as "moderate to severe" but there's no discussion in the context of the x-rays done before the cat died. It's difficult to discern an animal that was truly going to die from one that was as good as dead based on veterinary standards of care. Another question might discuss that the x-rays after the procedure state the lungs were clear yet the necropsy said there was significant acute pulmonary congestion and edema; one wonders if someone else could have stabilized or otherwise helped the situation had the problem been identified.
Regarding the overall standard of care in the veterinary sector regarding this issue, Heidi Shafford, a veterinary anesthesiologist once cited as an expert witness in another complaint, wrote about anesthetic approaches to cats with hypertrophic cardiomyopathy in Anesthesia for Feline Patients With Heart Disease (link). She suggests that plasma NT-ProBNP could be used as a general pre-anesthetic screening test for hidden hypertrophic cardiomyopathy and believes it should be obligatory in older cats (this cat was rather young). She also cites a study by none other than Arizona's own traveling cardiologist Christopher Paige, Prevalence of cardiomyopathy in apparently healthy cats, suggesting occurrence as high as 16%.
Rubalcaba probably didn't do anything worse than any of his fellow veterinarians unless he somehow missed earlier signs of congestive heart failure. Lives are just part of the cost of doing business.
| Source: | September 9, 2021 PM Investigative Committee Meeting |
|---|---|
| People: | |
| David Stoll | Respondent Attorney |
| Dylan Rubalcaba | Respondent |
| Roll Call: | |
| Adam Almaraz | Aye |
| Amrit Rai | Aye |
| Brian Sidaway | Aye |
| Steven Dow | Aye |
| Result: | Passed |
| Source: | October 10, 2021 Board Meeting |
|---|---|
| People: | |
| David Stoll | Respondent Attorney |
| Proposed By: | Robyn Jaynes |
| Seconded By: | Darren Wright |
| 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 | 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.