| Complaint: | Complaint 22-43 |
|---|---|
| Respondent: | Derek Matthews |
| Premises: | VetMed |
| Related: | 22-44, 22-45 |
The complainant includes a timeline. Her dog was examined for a dental cleaning where arrhythmias were diagnosed. The dog was referred to Miller at VetMed who eventually recommended a pacemaker; however, the last recheck before the pacemaker procedure was normal and Miller stated he wouldn't go forward if it were his dog. Several months later the dog appeared lethargic and there were discussions about the pacemaker; however, a full workup found a slight heart enlargement so the pacemaker option "was taken off the table." The dog was instead put on pimobendan and did well. At their last visit with Miller before his retirement, he allegedly stated that he believed the dog's death would likely be from congestive heart failure rather than the arrhythmias.
The dog was subsequently seen by Matthews and Hubert. The report was said to be good and only showed a small progression of the heart condition. Hubert prescribed spironolactone to prevent fluid buildup as a precaution, but the complainant notes that there were no issues with fluid in his lungs at the time. Two days later the dog became violently ill but VetMed advised her to continue with the spironolactone. Five days later the dog began experiencing episodes of collapse. She was told to bring the dog in to VetMed for observation and did so, where the dog was seen by Matthews and Turner. She went home to bring back the dog's medicine for him, at which point VetMed called her and told her to just come back and pick up her dog; there was nothing they could do. She states that she later read that spironolactone can cause a slower heart rate and believes the addition of spironolactone caused the dog's decline.
She went ahead and discontinued the spironolactone but the dog's episodes of collapse continued. She also relates that over the next 37 days she believed her dog could pull through, but she claims the dog's heart rate never recovered from the addition of the drug. The dog was eventually euthanized at BluePearl; she states that no fluid buildup was found and that the dog was not in heart failure when he died. She also questions why the dog was put on spironolactone in the first place and has concerns that nobody took into account the possible side-effects.
Matthews' response states that the dog was first seen by Miller and a workup was performed. Serious arrhythmia was identified that put the dog at risk of sudden death; medications were not an option and a permanent pacemaker was suggested. He first examined the dog in preparation for the pacemaker surgery, but as the dog's arrhythmias were improving, the surgery was canceled. He states that Miller sought his opinion and he concurred. Test results continued to improve. Matthews claims that several months later the dog began experiencing episodes of collapse that led to Miller prescribing pimobendan; other medications had previously been changed to avoid liver damage. The complainant later became concerned her dog was in congestive heart failure but x-rays taken at the family vet and reviewed by Miller showed no abnormalities; she attempted to make an appointment that February but Miller had quit and VetMed had no openings until July (!).
The remainder of Matthews' response pertains to that July visit and its aftereffects. He claims that the arrhythmias has actually worsened and the dog's heart enlargement was significantly worse as well. He believed that the dog was at risk of developing congestive heart failure "within the coming weeks to months" and added spironolactone as a preventative. He explains the pharmacology behind the choice and states that's generally a safe drug when not given alongside an ACE inhibitor; GI upset is considered a rare side effect and the dog was to be rechecked for electrolyte changes. They also recommended implanting a pacemaker, stating that while the dog's lifespan would not be improved, the dog's quality of life could be. The complainant allegedly turned down the chance to speak with Matthews directly, instead only speaking with Hubert, and later reported no problems on a follow-up call. Matthews subsequently went on vacation to North Dakota and was unavailable.
The complainant allegedly called in reporting the dog was having GI issues after starting spironolactone and CBD treats. She was advised to discontinue the CBD treats. Later that day the complainant called back and reported her dog had collapsed. Hubert recommended discontinuing both the CBD treats and the spironolactone; it appears Hubert also suggested the incidents of collapse were caused by "underlying orthopedic disease" and that another painkiller may help. The dog was brought in and the underlying arrhythmias were found to have worsened; a decreased heart rate was also found. The complainant turned down an option to implant the pacemaker, saying it was up to God now.
The dog continued to decline over the next month, including episodes of either syncope or seizures. The complainant was concerned about the dosing of spironolactone and so the difference between mg and mg/kg was explained to her. She also became concerned about confusion in the medical records (described as a "typo") relating to the dose of pimobendan. Both Matthews and Hubert quit VetMed on the same day in August and were no longer around for the remainder; the complainant continued to take up her concerns with others at VetMed. The hospital manager, Stephanie Foote, stated that the complaniant "is carrying a lot of guilt, grief, and loneliness" and put her in touch with grief support.
For a rather complicated case, the alleged doctors on the alleged investigative committee had little to say. They stated the complainant was very dedicated to the dog's care but that they didn't believe the spironolactone caused any of the problems; instead, they proposed that it might have been the CBD treats. (Veterinary literature is widely supportive of using spironolactone in dogs already in congestive heart failure; the 2019 HOMAGE study in humans missed its primary endpoints regarding spironolactone to prevent heart failure, but some results were considered promising enough to merit further study. And none of that speaks to the dog's arrhythmias one way or the other.)
| Source: | March 3, 2022 PM Investigative Committee Meeting |
|---|---|
| People: | |
| Derek Matthews | Respondent |
| David Stoll | Respondent Attorney |
| Roll Call: | |
| Adam Almaraz | Aye |
| Amrit Rai | Aye |
| Gregg Maura | Aye |
| Justin McCormick | Aye |
| Steven Dow | Aye |
| Result: | Passed |
| Source: | April 4, 2022 Board Meeting |
|---|---|
| People: | |
| David Stoll | Respondent Attorney |
| Proposed By: | Craig Nausley |
| Seconded By: | Darren Wright |
| Roll Call: | |
| Craig Nausley | Aye |
| Darren Wright | Aye |
| J Greg Byrne | Aye |
| Jane Soloman | Aye |
| Jessica Creager | Aye |
| Jim Loughead | Aye |
| Melissa Thompson | Aye |
| Nikki Frost | Aye |
| Robyn Jaynes | 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.