A warning regarding the quality of care provided by Dr. Ron Earp of Laurelwood Animal Hospital in Beaverton, Oregon.
A complaint which was the basis of the Oregon Veterinary Board’s decision to investigate Dr. Ron Earp will be published shortly.
Oregon Veterinary Medical Examining Board
800 NE Oregon Street
Suite 407
Portland, OR 97232
Dear OVMEB,
I. Introduction
(1) This complaint is against:
Dr. Ronald F. Earp (License # 4012)
Laurelwood Animal Hospital
9315 SW Beaverton-Hillsdale Highway
Beaverton, Oregon 97005
Telephone: 971-244-4230
Fax: 503-292-6808
Over the last year since our dog’s death on 2/29/08, we consulted with the following three veterinarians about how our dog’s case was handled from 3/19/07 to 2/29/08.
1) North Portland Veterinary Hospital
2) Dove Lewis Emergency Animal Hospital
3) Columbia River Veterinary Specialists
Our complaint against Dr. Earp is based on discussions with veterinarian from those distinguished veterinary hospitals, and the consensus in discussed in II and III below.
Our dog: Female yellow Labrador; born 4/7/96.
Our type of complaint against Dr. Earp, as explained to us by the above veterinarians, can be described in several ways, for example: (1) Repeated instances of the failure to meet minimal competency in practicing veterinary medicine; and/or (2) Repeated instances of the failure to employ a reasonable standard of care, where what is reasonable is that which is determined by what most veterinarians would do and not do.
We were also advised to cite the following statutes of the Veterinary Practice Act, and in this complaint we argue that Dr. Earp violated the following statutes.
875-011-0010
(2) A pattern, practice or continuous course of negligence, ignorance, incompetence or inefficiency in the practice of veterinary medicine. The incidents may be dissimilar.
(7) Failure to use generally accepted diagnostic procedures and treatments, without good cause.
(12) Failure to maintain records which show, at a minimum, the name of the client, identification of the patient, its condition upon presentation, the tentative diagnosis, treatment performed, drug administered, amount of drug, any prescription, and the date of treatment. For companion animals, identification of the patient should include species, breed, name, age, sex, color, and distinctive markings, where practical.
875-015-0030
(1) Medical Records: A legible individual record shall be maintained for each animal.
(g) Pertinent history and presenting complaint;
If in your investigation you find that Dr. Earp, and other veterinarians involved, engaged in other statue violations, or other general violations, we would like to ask that complaints of these violations be included in our complaint.
(2) I’d first like to include what I believe is a relevant context for our complaint, namely, the role we had in our dog’s social, developmental, physical, and medical life. We were co-owners of our dog, and thoroughly discussed every aspect of our dog’s medical care. We were intensely devoted to our dogs quality of life, and we provide the following information as context for our complaint: (a) we made it clear to all veterinarians throughout her life that the cost of appointments, time needed to go to appointments, management of treatments (therapy, medicines, supplements, etc), were not issues in any sense and at any time; Dr. McCoy (listed above) was our dog’s veterinarian from 0-10 years old, and he will attest to how we telephoned him whenever the slightest problem arose, and that we went to all appointments asked for by him, and followed all of his medical instructions with great care; in general, he will attest, as he has done to us ourselves, that we were extremely involved and extremely concerned owners; and he will also attest to how we were not “unreasonably concerned”, meaning that we did not call his office when lacking any reasonable basis to do so, and likewise that we did not subject our dog to unnecessary appointments and physical exams based on our own unreasonable and baseless fears/speculations/etc; (b) our dog received Monday-Friday daily exercise of 2-4 hours per day, mainly doing vigorous hiking and trail workouts, and Saturday-Sunday daily 1-2 hours of lighter exercise; weekly total averaged about 40 miles and about 15,000 vertical feet; (c) to maximize our dog’s social quality of life, our dog was essentially never left alone for more than 1-2 hours maximum a day, and most days was either never alone or only so for 30 minutes or so; (d) we fed our dog the highest quality organic dog food, and over the last 4 years, primarily raw handmade food at about $150 a month and following a well established basic recipe; (e) since our dog was exercising on the park trails every day often in the rain and mud, we bathed our dog 2-3 times a month, and thoroughly rinsed our dog after the completion of each day’s exercise; (f) we brushed our dog’s teeth 4-6 times a week thoroughly, brushed fur 2-3 times a week thoroughly, clipped nails every other week, and used ear-wash to wash the inner ears twice a month; (g) we followed all vaccine recommendations, we used preventative monthly heart-worm medicine, we did all recommended in-office exams; (h) in the event of any apparent symptom appearing, we would immediately call the doctor to discuss our observations and ask if an exam was needed.
II. Summary
We will start with summarizing the above mentioned veterinarian’s general consensus about Dr. Earp, which also are summaries of our complaints. Here at times we will discuss some specific complaints.
(1) There were a multitude of instances from 3/19/07 through 2/29/08 of Earp’s failure to manage our dog’s medical care in a minimally competent way. That is:
(a) He made diagnoses that most veterinarians would not make.
(b) He didn’t make diagnoses that most veterinarians would make.
(c) He did not perform certain types of exams, nor order certain types of tests, that would be both obviously warranted to most veterinarians, and which most veterinarians would do.
(d) He skipped many diagnostic steps that most doctors would not skip given the presenting symptoms of our dog.
(e) He provided us, at many initial appointments, with a diagnostic plan for the future that most doctors would not do. For example, as will be discussed below this summary, upon our describing a multitude of symptoms to him (straining to defecate, flattened stools, increased frequency of urination and increased urgency to urinate, and increase drinking of water), he did not do a rectal exam (not on 3/19/07, nor in mid-February 2008; and nor in late January 2008 due to his failure to ask for what most doctors would believe to be a very warranted physical exam); instead he prescribed metronidazole at each time (and on one occasion over the telephone), and indicated the next step would be a stool sample, then possibly a bacterial culture, and then possibly an endoscopy, and stressed that the endoscopy would be the very last resort and that it is highly invasive and not something he usually recommends doing nor wants to do. The other doctors we consulted stated that they, and most other doctors, given the specific symptoms that we described to the doctor, would have not done what Earp did, and instead, would have done a rectal exam immediately, an abdominal x-ray immediately, and then gone from there in terms of additional possible steps based on the exam and test results, which could include anything from the need for additional x-rays, to a surgical consultation and oncologist consultation, to prescribing metronidazole and/or other medicines, etc.
(f) Earp’s first rectal exam was done at a very late stage (2/26/08; 3 days prior to our dog’s death on 2/29/08), and he failed to detect something that was easily detected by two doctors shortly thereafter (in 1/2 day by Dr. Robert Franklin 503-292-3001 board certified in internal medicine, and in 2 days by Dr. Amelia Simpson 503-292-0931 board certified surgeon), indicating his inability to do that type of exam in a minimally competent manner; and, what the two other doctors found was of the nature that shows that Earp is not minimally competent at performing that exam; and, one of the doctors (Dr. Amelia Simpson,) commented that she was able to make her detection of the problem “even with my small fingers”, and was able to do so quickly.
(g) He often prescribed and managed medicines via telephone when most veterinarians would (a) ask for exams prior to prescribing, and (b) ask for additional exams when changes in medicine dose and schedule were made, and when discontinuation of certain medicines and initiating of different medicines were made. Earp never asked for many exams that most veterinarians would both ask for, and, find obviously warranted given the symptom-descriptions we provided to him. Moreover, most veterinarians would want to make their own in-office assessment of the dog’s condition during the time the dog has been receiving medicine, especially when making decisions to change the medicine dose and schedule, and especially when discontinuing a medicine and/or starting a new medicine, rather than relying on the dog owner’s assessment. Moreover, Earp often advised us against the need for exams, stating it was unnecessary, in repeated instances when most veterinarians would both not make this determination via telephone, and, given the extensive and clearly described symptom-descriptions we provided him repeatedly and over time, find the need for the exams obviously warranted.
(2) There were apparent repeated instances of Earp engaging in unethical conduct. The following are not summaries like the above (II 1 a-g), but rather, are the basic details of this aspect of our complaint. We placed this aspect of our complaint here because it provides, we believe, an important foundation for the other specific complaints against Earp. The foundation being, as we discuss below, that we deterred by Earp in a purposeful, strategic, persuasive, and dishonest manner from seeking any second opinions throughout our relationship with him, including seeking a second opinion from his hospital partner Dr. Lynn Eardman. In part (b) below there is a related instance of apparent ethical misconduct.
(a) During each appointment, and each phone call, he informed us that his colleague in the neighboring specialist veterinary facility, Dr. Robert Franklin of the Oregon Veterinary Specialty Hospital, 503-292-3001, was in agreement with each of his decisions, and Earp would reiterate, often several times in an appointment and phone call, that Franklin is a “board certified specialist in veterinary internal medicine”, that he is “a distinguished specialist and satisfies and resolves any need for a second opinion”, and would represent him as being intimately involved in the management of our dog’s medical care. Moreover, at the times we would ask Earp questions (and we would do so always in a neutral, academic manner) after he made his concluding decisions in the office or on the telephone about whether certain things should be looked at with an exam, or x-rays done, or other tests, or if we should get another opinion from his partner Dr. Lynn Eardman, or another veterinarian, he consistently would reply with the above mentioned things about Franklin. This led us to believe he was collaborating with Franklin on all of his decisions. Moreover, Earp told us that we would be subjecting our dog to unnecessary exams, tests, and office visits if we went to his partner Eardman or another veterinarian. However, in our two lengthy telephone conversations with Franklin after our dog’s death, which was the first time we spoke with him about our dog’s medical history, (history over the year prior to our dog’s death; we had never met or spoken with him prior to 2/26/08), we asked him about our dog’s symptoms over the previous year, especially the previous two months, and asked whether anything should have been done sooner, or could have been done sooner, and he stated that he is not able to speculate about our dog’s condition in the past because he was not familiar with our dog’s medical history, past treatment, past diagnoses, test results, etc. We then said that we thought he was involved in our dog’s case as the supervising and second-opinion veterinarian from the start (7/26/06) and especially from 3/19/07 onward, and that we thought that he took over our dog’s case on 1/26/08. He replied (and often laughed, as if to indicate that we made our own poor assumption) that he did not take over our dog’s case at any time, and that his first familiarity with our dog’s case began on 1/26/08 when he did his own exam on our dog and discussed our dog with Earp. We then mentioned that Earp directly informed us that he was involved in this way, and Franklin became quickly irritated and said “I’m not sure what you want or what you’re getting at. Hindsight is 20/20 and we can go over everything over and over but it won’t change anything.”
(b) The following is a related apparent ethical violation with regard to how Earp responded to our bringing to his attention what we later confirmed with the above 3rd party veterinarians to be proper complaints. We, and the 3rd party veterinarians, believe the following shows that Earp is substantially dishonest, lacks self-accountability, intentionally tries to deceive, and fails to follow basic ethical standards. This is in addition to being apparently not minimally competent. In the few days prior to our dog’s death on Friday 2-29-08, and in the week afterward, we brought to Earp’s attention some concerns that arose with regard to his standard of care, asking him (1) why he did not detect the anal gland tumor on Monday during his rectal exam, and (2) why he did not do a chest x-ray on Tuesday in light of how the Tuesday abdominal x-ray showed a massive sub-lumbar tumor and in light of how the anal glad tumor (found on Tuesday by Dr. Franklin during his rectal exam) was found to be cancerous (adenocarcinoma). Again, the veterinarians I consulted with state that both they and most doctors, given the nature of the anal gland tumor and how it was easily detected on Tuesday and again on Friday, would have detected the anal gland tumor not only on Monday, but very probably many weeks to possibly months before (especially in light of the myriad of symptoms presenting 2 months before (flattened stools, straining, etc); and they further state that they would have ordered a chest x-ray on Tuesday given the findings on Tuesday. Regarding the rectal exam issue we raised to him, he responded “I wasn’t feeling the sides; I was feeling straight in.” Regarding the x-ray issue, he responded to us that “I didn’t think you wanted me to do another x-ray, because I know how much you care for Caddis.” And, “I don’t like to subject animals to possibly unnecessary radiation.” However, (and this was our response to him), he never told us he wanted to do an x-ray, nor that one was warranted; that is, he never gave it to us as an option to decide on. We further responded that we would have without any question agreed to any additional x-rays that he wanted to do, and that we never in our dog’s 12 year history declined any tests, exams, x-rays, medicines, basic vaccines, blood tests, etc, ordered by any veterinarian, and that our care for our dog entails doing all exams and tests ordered by our dog’s veterinarian. We further responded that we found it extremely strange to be told that x-ray radiation is concern and constraint to doing warranted x-rays. We further responded to him that we found it extremely strange and confusing that he would merely assume we didn’t want an x-ray done; and extremely strange and fairly incoherent and illogical that he made this assumption based on how much we care for our dog. Again, “I didn’t think you wanted me to do another x-ray, because I know how much you care for Caddis.” The other doctors I consulted with consider this to be at about the highest level of atypical, inappropriate, and illogical, and an unfortunate sign of the poor quality of his reasoning, his assumptions, and his communicative ability. To all of this Earp did not reply. He replied later via telephone with us on Thursday (a day before our dog’s death) that he felt that we, unfortunately, lost faith in him and did not trust him any longer, and told us it would be best that we thereafter consult another facility such as Dove Lewis Emergency Animal Hospital. (Some of this is noted by him in his medical records on 2/29/08 8:00am, the day of our dog’s death). A week after our dog’s death, we spoke with him via telephone about his apparent lack of minimal competence in doing a thorough rectal exam, and stated that we were confused at how two other doctors could easily detect the anal gland tumor on Tuesday and again Friday, and how, as each told us, they were able to easily detect the tumor with careful palpation of the entire area. We said that it seemed to us that a thorough exam entails feeling the entire area, rather than limiting the palpation, as he did, to “I wasn’t feeling the sides; I was feeling straight in for any obstruction.” He said in a very friendly way, “hindsight is 20/20” and “it wouldn’t have changed the prognosis”, and chuckled. He notes in his medical records on 2/26 “no obstruction”; many of the other words for this record-entry appear illegible.
III. Specific Complaints
(1) On 3/19/07, we contacted Earp via telephone to describe the following symptoms that began occurring on the previous day, and we asked for an appointment that day; and then; in-office; we reiterated the following symptoms. (a) Substantial straining to defecate: during walks, taking 4-5 times the usual time to attempt to defecate (1-3 minutes); 75% of the time during attempts to defecate, there was no defecation; walks were interrupted every about 5-10 minutes with attempts to defecate. (d) Our dog was holding the tail inward (between the legs and pulled inward below the abdomen) at all times when upright, that is, at all times when standing and walking. (c) Flattened stools. (d) A 4-5 time increase in the number of times having to urinate. (e) Rather than a gradual build-up to the time of urination, exhibited by, for example, going off the trail or road and taking moments to find a place to urinate (which is something our dog consistently did), our dog would abruptly urinate on the trail or road, that is, our dog would be walking and then abruptly stop and urinate simultaneously. (f) Our dog was drinking about 2 times the usual water, that is, drinking double of the amount of bowls of water. (g) Our dog was urinating 4-5 times the usual frequency of times, and the length of the urinations was considerably longer.
(a) The above listed DVM’s we consulted with recommended that we state in our complaint that (a) most of our symptom descriptions were not recorded in our dog’s medical records, (b) of the symptoms Earp noted, they are done so in an incomplete manner, that is, they don’t provide the full details and nature of the symptoms, and (c) Earp’s medical records are highly incomplete (lacking in the basic required information as specified by the Oregon Veterinary Practice Act), and are mostly illegible, and mostly unusable by other doctors who may need to read the records for various purposes (diagnoses, treatment, etc).
(b) Earp diagnosed Cold Water Tail Syndrome, and informed us of this; and later in the office he said “this diagnoses is supported by board certified Internist Dr. Franklin.” We then asked some questions to understand the diagnosis, such as how it could be relevant in light of how our dog is essentially never in any water (whether cold or warm), that is, that our dog had not been in water nor swimming for countless months, and that in the 1-2 times a year we go swimming, it’s usually very brief, such as for 10-15 minutes. Earp became agitated that we questioned him, and vaguely stated that the condition can present itself in other circumstances, and reiterated that Franklin was in agreement with him. The above listed DVM’s consulted with state there is no basis whatsoever for this diagnosis based on our extensive and clearly articulated symptom-descriptions, and they further stated that no doctors they know would make this diagnosis given our symptom descriptions. The above listed DVM’s further state: (a) such as diagnosis is only relevant to hunting or working dogs who spend considerable time in cold water, or unconditioned dogs subjected to high physical demands walking and running over considerable time; (b) the nature of the tail problem in Cold Water Tail Syndrome is not that it is pulled all the way down, and between the legs, and under the abdomen, but rather, that it is essentially normally held outward at the based, but that the outer half of the tail droops downward, that is, there is no holding of the entire tail between the legs; (c) in their exams, they would have immediately done a rectal exam as their first order of action, as this was the most obviously warranted exam; and they state that most doctors would have found immediate warrant to do this exam; they further state that regardless of their rectal exam findings, they would have also done an x-ray of the entire abdominal area, and that most doctors would do this as well; (d) they would have done these exams and tests prior to prescribing any medicine; (e) Earp’s prescription of Rimadyl, and later Metronidazole, were not appropriate in light of the absence of the above exams and tests.
(c) Earp diagnosed the other symptoms besides the tail symptom as being separate issues, and told us that some symptoms were directly that of colitis and inflammation, and that the other symptoms were caused by colitis. He said he therefore wanted to prescribe Rimadyl for the inflammation and colitis, and later if not effective, possibly Tramadol. The above DVM’s we consulted with stated the following: (a) they, and most doctors, would have considered the inward held tail and other symptoms, especially in light of how the symptoms began occurring together and abruptly so one day before 3/19/07, to be caused by one underlying condition, and would have pursued a course of action based on this (e.g. rectal exam, x-rays, etc), (b) some DVM’s believe they are engaging in exceptionally skilled diagnoses when they put forward a diagnoses of a relatively rare and atypical condition (Cold Water Tail Syndrome), and, they believe they are doing so as well when they separate a myriad of symptoms into having different causes and not necessarily being of the same underlying condition, (c) in our dog’s case, and in light of our dog’s history, types of activity, and our specific symptom-descriptions, this diagnosis did not have any foundation; and, given how the symptoms began occurring together, and rapidly so, the day before our appointment, there was no basis to think the symptoms were caused by unrelated conditions, that is, Cold Water Tail Syndrome for the tail, and another unrelated condition (colitis) causing the other symptoms (straining, etc).
(d) From 3/22/07 to about 3/29/07, Earp managed our dog’s condition via telephone, managing medicine changes, and medicine additions and discontinuations, and relying on our assessment of the changes in our dog’s condition when on the various medicines. Rimadyl was first prescribed on the day of the first appointment 3/19/07, and given no improvement, he prescribed Metronidazole on 3/22/07 and discontinued Rimadyl; then given still no improvement in the tail problem on 3/26/07, he re-started Rimadyl and stopped the Metronidazole; on 3/28/07 we reported improvement in our dog’s condition, and Earp attributes this to the Rimadyl in his medical records. The above listed DVM’s state the following: (a) The going back and for with the medicines is an instance of incompetence, as this does not permit a doctor to know with certainty what medicine, if any, is helping, and secondly, most doctors would not do this; (b) relying entirely on us for our assessment of our dog’s condition (that is, with no further in-office exams) is an instance of incompetence: he should have asked for follow up exams at times of medicine changes, in order to make his own in-office exam, and also speak with us at that time taking into consideration our observations.
(e) Related: Earp, starting in 1/30/08, and again on 2/20/08 and 2/21/08, and in the week of our dog’s death (2/26/09-2/29/09), and in the weeks afterward when speaking with he and Franklin, told us that he began considering Metronidazole on 1/30/08, and later prescribed it on 2/21/08, because of our dog’s favorable response to it in March 2007. However, as noted in his records, on 3/28/2007, he attributes our dog’s improvement to the Rimadyl. At that time in March 2007, he further told us on the telephone that he determined the straining, urinating, and flattened stools to be caused by colitis inflammation, due to the success of the Rimadyl, and due to how the Metronidazole was not effective. The above DVM’s consulted stated the following: (a) From 1/30/08 onward, Earp likely could not read his own medical records for the time period of 3/19-29/07 (due to their illegibility), or, that he only carelessly glanced at them, and this is likely why he believed the Metronidazole was effective during that time period;
(f) The above listed DVM’s stated that they, on 3/19/07, would have found our dog’s change in normal urination habits, flattened stools, and straining to defecate, to be concerning and to warrant an immediate rectal exam and x-ray. They further stated that flattened stools are often indicative of a mass causing the stools to be flattened in shape, and that these symptoms should have been investigated thoroughly at that time. They further that they believe that most doctors would make the aforementioned assessments, and, take the aforementioned courses of action.
(g) We called Earp on 1/30/08 to inform him of a multitude of symptoms, and to inform him that such symptoms had been developing gradually since our previous phone call to him on 1/5/08. The symptoms we described to him were the same as the ones we described to him on 3/19/07 (listed above) except for the tail being held inward. (1) Substantial straining to defecate: during walks, taking 4-5 times the usual time to attempt to defecate (1-3 minutes); 75% of the time during attempts to defecate, there was no defecation; walks were interrupted every about 5-10 minutes with attempts to defecate. (2) Flattened stools. (4) A 4-5 time increase in the number of times having to urinate. (5) Rather than a gradual build-up to the time of urination, exhibited by, for example, going off the trail or road and taking moments to find a place to urinate (which is something our dog consistently did), our dog would abruptly urinate on the trail or road, that is, our dog would be walking and then abruptly stop and urinate simultaneously. (6) Our dog was drinking about 2 times the usual water, that is, drinking double of the amount of bowls of water. (7) Our dog was urinating 4-5 times the usual frequency of times, and the length of the urinations was considerably longer.
(g1) Earp did not record our symptom-descriptions in a complete manner in his medical records; and he omitted many symptoms; there is no record of our phone call to him on 1/5/08; on 1/5/08 and 1/30/08 he stated several times: “I’m not too concerned”; “These types of things are common and if I asked people to come in each time this happens I’d be having people come in all the time and spending a lot unnecessary money … Maybe a dog ate something or just has an upset stomach.” On 1/30/08 he said he would consider prescribing Metronidazole and maybe a fecal sample, but he stressed to us that this was probably unnecessary and said he was uncertain about prescribing it. He left us with thinking that our dog simply had routine non-medical problems that would resolve over time. He stated that his board certified internist Dr. Franklin was in agreement with him. He did not ask for an exam. He did not state that he would do an exam if we wanted. He stressed that an exam was unnecessary.
(g2) The above veterinarians we consulted state they would have asked for a full physical examination on both 1/5/08 and 1/30/08; and given our symptom descriptions, they each state they would have done, on both dates, and at a minimum, a rectal exam (and had another doctor at their offices also do a rectal exam for a 2nd assessment), an abdominal x-ray series (different x-ray views), and a complete blood test. Further, there is speculation that the problem originated in mid-March 2007 (given the essentially same presentation of symptoms in March 2007 and January 2008) and then entered a dormant or remission-like period from then onward until about January 2008.
(As will be noted below in more detail in our discussion of what occurred in the week of our dog’s death: Beginning in August 2007, several times a week, we began to find small brown spots on the various couch and bedding areas that our dog sat and rested on, which were found to be fecal spots. Earp was informed of this in our early August and early October appointments. He stated: “I’m not concerned, it sounds normal, it likely is due to the sitting angle or the tail at times not being between the anus and the bedding.” However, this was a completely new occurrence, and, the above veterinarians consulted with stated they would have immediately done a rectal exam and full exam given this new change, and, they would be especially concerned with these exams given our dog’s symptom presentation in March 2007. There is speculation that Earp has an aversion to doing rectal exams: (1) he repeatedly avoided doing them even though they were highly indicated, (2) when he did his first rectal exam on 2/26/08 (three days before our dog’s death) he failed to detect a tumor that was easily detected by two doctors shortly thereafter (in 1/2 day by Dr. Robert Franklin 503-292-3001 board certified in internal medicine, and in 2 days by Dr. Amelia Simpson 503-292-0931 board certified surgeon), indicating his inability to do that type of exam in a minimally competent manner; and, what the two other doctors found was of the nature that shows that Earp is not minimally competent at performing that exam; and, one of the doctors (Dr. Amelia Simpson,) commented that she was able to make her detection of the problem “even with my small fingers”, and was able to do so quickly, and (3) when we asked Earp shortly before our dog’s death, and in the week afterward, why he didn’t detect the tumor on 2/26/08, he commented “I wasn’t feeling the sides; I was feeling straight in for any obstruction”; the veterinarians consulted with each state that they find Earp’s explanation surprising, unfortunate, and a showing of his lack of minimal proficiency in conducting a standard rectal exam, which involves palpating all areas of the rectal walls and within the rectal cavity).
(g3) There are various speculations about why Earp did not do what most other veterinarians would find obviously warranted (as discussed above), and two common themes that have arisen in our discussions are the following: (1) That he started his hospital with Dr. Lynn Eardman in 2006 and one of his primary goals appears to be to build a clientele by being convenient and less expensive for clients, e.g., by not asking for in-office exams that most other doctors would immediately ask for, by prescribing medicines over the phone as an alternative to an in-office exam, by trying to resolve medical questions and problems over the phone, by airing on the opposite side of caution in order to avoid having clients come in for what appears to him to be routine problems that may resolve on their own, and by telling clients that his decisions are supported by board certified internist Dr. Franklin, in order to dissuade them from seeking second opinions and possibly leaving his hospital for another hospital. This apparent approach by Earp would likely do well to attract maximal clients (as a great number of people are drawn to veterinarians who are convenient in this way), and this approach would entail putting priority on client-building rather than medical treatment, which would be unethical. Lastly, as we stated above, our going to appointments and their costs were of no concern to us; and we are known by friends and our past veterinarian (Dr. Don McCoy, listed above) as being immensely more vigilant about our dog’s care than most other people, calling the veterinarian for all concerns, going to all appointments that a veterinarian recommends, never missing any appointments, never raising concerns about any medical costs, etc. (2) Another speculation that has arisen is that Earp is imposing his value of animal life on his clients, that is, that his level of value for animal life is such that he doesn’t feel obligated to engage in careful, time-consuming, and often costly preventative medicine: that he doesn’t feel compelled to do x-rays, rectal exams, and other similar exams at any time an animal presents with a problem that warrants these exams; that it’s better for an animal and their owners to have a minimum of in-office exams, tests, procedures, etc, unless the medical situation is at an extreme level; that it’s better in most cases, for both the owners and animals, especially with older animals, to have an animal die of disease without repeated in-office exams, tests, procedures, surgeries, etc, than to have the animal’s life prolonged to some degree with these things. What we discussed above briefly (II 2b, and III g1), and what we will further discuss below in (h), appear to indicate that this may be the case for Earp. Both of the above positions appear to be the case for Earp. Both would be contrary to the Oregon Veterinary Practice Act and the Veterinarian’s Oath of the American Veterinary Association. (3) Another speculation is that Earp and Franklin intentionally decided to not do a chest x-ray on 2/27/08 because they thought that the possible results, and likely results (given the size of the sub-lumbar tumor), would be too difficult for us to handle psychologically. They observed our psychological response to the abdominal x-ray (marked sadness) and possibly decided to forgo the chest x-ray due to this, and let the surgeon specialist Simpson do the x-ray later in the week. The other veterinarians we consulted concur that a chest x-ray was highly warranted, and extremely obviously so, and that any doctor with minimal competence would have ordered it. Given how obviously warranted it was, there is strong speculation that Earp and Franklin decided to forgo the chest x-ray for reasons outside of the purview of veterinary medicine, that is, for reasons that were their own personal, non-medical reasons, based on their own personal, non-medical views and values. The consulting doctors, and many others, state that it was not their place to make such apparent judgments, that is, they should have not let their personal views affect their medical decisions.
(h) As noted in (II 2b, and III g1), in the week of and after our dog’s death, we spoke with Earp at length about (1) why nothing was done in early January 2008 (the 5th), (2) why nothing was done in late January 2008 (30th), (3) why he started his treatment via telephone in mid-February with no examination given the myriad of significant symptoms, (4) why he failed to detect our dog’s anal gland tumor, (5) why he didn’t do an rectal exam in 3/2007, nor an xray in 3/2007, (6) why he believed the Metronidazole was the cause of our dog’s improvement in 2007, when in fact it was the Rimadyl (as the Metronidazole had been discontinued; and quickly after administration of the Rimadyl our dog improved; and then, as noted in the records, our dog regressed shortly after discontinuing the Rimadyl; and shortly thereafter improved again after resumption of the Rimadyl), (5) why he didn’t do a chest x-ray on 2/26, (6) why we weren’t given a referral to a surgeon on the 27th or the 28th at the latest, (7) why he doubted our reports of our dog’s escalating inability to defecate and urinate, and why he considered 1 tablespoon of feces being produced in 24 hours as being acceptable, and, the other concerns we discussed in this complaint. Like Franklin, he responded with “Hindsight is 20/20”, and provided the other explanations discussed in this complaint. We stressed that it would have been very important to us to have as early of a diagnosis as possible, and that it seemed clear that this could have been done many weeks and possible months prior, and at the very least, on the 26th. Like Franklin, he stated “This wouldn’t have made any difference for prognosis.” We said that with a 26th thorough diagnosis, at the least, this would have allowed us to know right away about our dog’s condition, which would have been important to us in many ways. Further, we said, with a 26th thorough diagnosis, there would have been no referral to a surgeon, as it would have been clear the case was not treatable, due to the spread of cancer to the lungs, and did not have a maximal prognosis beyond about 4-6 weeks. Earp did not reply. This was a prognosis that would have been made prior to the escalating gastrointestinal symptoms. After the 26th, the prognosis became a matter of (1) either days due to starvation from not eating, or (2) very questionably 4-6 weeks after palliative surgery of the sub-lumbar tumor; questionable because, as Simpson said, it was very uncertain whether our dog would survive the surgery given the extent of the sub-lumbar tumor and it’s having encroached upon the spine in many areas, and given the cancerous tumors found in the chest xray (while small and not causing any respiratory symptoms, they would have likely grown rapidly as the sub-lumbar tumor was doing).
(2) On 10-3-08, we called Dr. Earp at home at about 12:30am for an emergency call to report that our dog had swallowed most or all of a large, raw, cow knuckle bone. In about a five minute conversation, we discussed the matter and the options for treatment, and he provided two options, but was ambivalent about what to advise us to do, that is, whether to induce vomiting with hydrogen peroxide or to hope the bone would pass safely. This confused us. We administered the peroxide, waited about 5 minutes and called Earp again, and while on the phone with him our dog vomited a large bone fragment and several small fragments.
Earp did not record any aspect of our call in his medical records; there is nothing listed for 10-3-08, nor any other date, nor any mention of this situation anywhere in his medical records.
(3) From early 6/2007 to 1/2008, at least 4 times (possibly more), including at two appointments (8/19/07 and 10/5/07), we informed Earp of, and showed him in person, our dog’s clearly newly developed loss of muscle in certain areas, such as the back of the thighs, and shoulders. We also informed him of and showed him the presence of bony prominences not noticed before in these areas. We also informed him of frequently occurring spasms/tremors in our dogs left knee (stifle) and thigh area; that the spasms were fine and rapid in nature, and would occur in bursts of time, e.g., every about 10 seconds for 15 minutes, then re-occur several hours later, or, not until 1-3 days later; that the spasms were only noticeable when our dog was laying down, and that they would often also occur when our dog was sleeping. We said we didn’t change our dog’s level of exercise, nor anything else. He consistently replied “I’m not concerned”. I asked if this was related to what our dog developed in mid-March 2007 (discussed above in III 1 a-g3), and he said “No”, and that he would discuss it further with Dr. Franklin and let us know if there were any concerns; he never brought any concerns to our attention, so we thought Franklin advised him there were no concerns. About the spasms, he said that it’s normal and likely due to exercise. I said these spasms never occurred before in our dog, and he didn’t reply. I asked if an x-ray of the leg and back area should be done, and he became irritated and stated that he and Franklin think this would be unnecessary.
We are unable to find any notes about the above in our dog’s medical records.
The above veterinarians with whom we consulted state that the relatively rapid loss of muscle and presence of bony prominences, and tremors, would have been concerning and warranted a number of tests (among the several they mentioned, a complete blood test, stool sample, rectal exam, a spinal and abdominal x-ray series, and possibly a chest x-ray); they further state that very likely this was related to the presence of developing cancer, which likely began developing in early March 2007, or possibly before. (3/19/2007 (discussed above in III 1 a-g3) is when we brought to Earp’s attention the rapid development of a multitude of gastrointestinal symptoms). They further state that the leg spasms were likely due to the impingement of the sub-lumbar tumor on areas of the spine; and the abdominal x-ray shows the sub-lumbar tumor apparently impinging on the spine in many areas, and possibly invading the spine in some areas. The consulting veterinarians also state the following about Earp: given that he essentially ignored most things in March 2007, and avoided obviously warranted exams, and made a highly questionable, unusual, and unwarranted diagnosis (Cold Water Tail Syndrome), that at the least, starting in 6/2007, this was a second instance for him that warranted a through investigation, and serious re-consideration of what occurred in mid-3/2007.
(4) Above in many sections, such as at (III 1 g-g2), we discussed in detail the many factors leading to our dog’s last series of appointments with Earp, Franklin, and Simpson from 2/26/08 to 2/29/08. We also discussed the history of the onset of our dog’s symptoms, as brought Earp’s attention starting in 1/5/08. We also discussed the multitude of other issues regarding Earp’s handling of our dog’s medical care from 1/5/08 to 2/28/08 (our final appointment with Earp and Franklin). We also discussed in detail the opinions of the veterinarians with whom we consulted about what Earp did and did not do, and what they would have done, and what they believe most veterinarians with minimal competency would have done.
Now we would like to discuss some other aspects of Earp and Franklin’s handling of our dog’s medical care from 2/26/08 to 2/28/08. Over this time, we asked Earp and Franklin about pain management for our dog. The straining to defecate escalated to a very severe level from the 26th-29th, including from the 25th onward having blood in the stools and around the anus, and our dog was wincing during defecation from the 26th-29th. Earp said on the 26th, and repeated each day to the afternoon of the 28th, that “Dr. Franklin said it would be best to not give any pain medicine”, which we found to be extremely confusing. We asked for an explanation and Earp kept shrugging his shoulders and referring to Dr. Franklin’s decision; and Earp reiterated Franklin is a board certified specialist. In the afternoon of the 28th, Earp responded to our continued questioning about this issue by stating that Franklin said that now it would be acceptable to administer a pain medicine. Since our dog was in pain from the 26th onward, we were left with thinking that pain management could have begun on the 26th. We then asked about the pain medicine Franklin decided on, and the different options available, and he explained Franklin decided on an injectable opiate drug, and then administered it himself on the top of our dog’s neck, and said our dog might have “some sedation” “for a while”. He did not explain the various pain management options (from over the counter to more powerful medicines). Within a half hour, our dog became profoundly sedated, and this lasted from 4pm throughout the evening and next morning, and began to decrease by about 6am. Directly caused by the medicine, our dog clearly was greatly disoriented, our dog did not appear to recognize us, nor the rooms of our house, would stare persistently, and at about 11pm began shivering for a few seconds about every minute. These were radical changes from how our dog was doing 30 minutes prior to being given the medicine. We called Earp about this starting 1 hour after he administered the drug, and he said this response was very unusual, and that he expected far less sedation. There is speculation that Earp/Franklin did not take into consideration, in deciding on the type of drug and dose, that our dog had not eaten anything (due to greatly diminished, and then lost, appetite) for about 10 hours; there is also speculation that Earp may have overdosed our dog; there is also speculation that there were many other less aggressive pain medicines available that would have been very sufficient in lessening the degree of our dog’s pain without incapacitating our dog’s basic cognitive and physical skills. We called Dove Lewis Animal Hospital and they said we should monitor our dog’s condition closely.
Regarding the drug that was given, in our dog’s medical records I could not find the drug name, nor the dose given.
Our consulting veterinarians concur that pain management should have begun immediately on the 26th, and also, in the two weeks prior to the 26th (along with the prescribed Metronidazole) when we reported the persistent straining and other symptoms. Our consulting veterinarians state there are a myriad of pain management options of different intensities that should have been used from the start, and that as veterinarians one of their fundamental purposes is to ensure whenever possible and reasonable that their animals has as much relief from pain as possible, and to monitor their pain vigilantly. Dr. Earp did not do this.
(5) From early 2/27 onward, we emphasized how our dog’s condition was escalating rapidly. The straining was getting worse to the point that, on 2/27, only a total of about 1-2 tablespoons of feces was being produced in 24 hours. On 2/28, our dog was no longer able to urinate when intentionally trying to do so in the usual seated position; our dog was only able to urinate small amounts accidentally when standing and walking about (2-3 tablespoons); we were instructed by Earp to express our dog’s bowels, which helped with evacuating more urine (about ¼ cup several times in the day). Early on 2/28 our dog began to reject all food. From early 2/28 onward, our dog began to stand with the back of the body in a hunched or stilted position. Earp prescribed a stool softener. Dr. Earp, from early 2/27 onward, in a total of four appointments and six phone calls, responded to each report of escalating symptoms as follows: (1) He said the xray showed that the feces were being moved out, and that he was confused about our reports, and that this issue with the feces being expelled normally didn’t seem to be an issue; the xray he was referring to was the single xray taken by him on 2/26; Earp clearly was failing to acknowledge the accuracy of our detailed reports to him of the escalating symptoms; he appeared to be highly skeptical of our reports. The consulting veterinarians said they would have done another abdominal xray to ascertain the extent of feces backup, and any other possible worsening structural problems since 2/26, in light of our dog’s escalating symptoms.
(5a) Dr. Earp and Franklin strongly, and repeatedly, advised us against taking our dog to Dove Lewis Emergency Animal Hospital for a surgery consultation, saying to us that Dove Lewis is often “too aggressive”. We asked what this meant, and they said that there would be a great risk taking our dog to Dove Lewis because they very possibly, and probably, would do to extensive of surgery, and/or do surgery on areas not entirely necessary, and/or do to extreme of surgery that could subject our dog to very possibly not surviving the surgery. (In retrospect, we now speculate that both Earp and Franklin (a) intentionally did not do the chest xray on 2/26 to postpone our knowledge of our dog’s terminal condition (a condition about which we speculate they had high certainty, given the massive sub-lumbar tumor and the rapidity of it’s growth), (b) advised against Dove Lewis because they didn’t want there to be any possibility of our dog being subject to surgery, (c) knew our dog was terminal and wanted us to see Dr. Simpson who they knew with more certainty would not do surgery). If this is the case, it is not within the purview of veterinary medicine for veterinarians to make medical judgments based on how they personally want a case to be handled. They are obligated to doing all warranted investigative tests and exams, and providing all information to the animal owners. And it is inappropriate that they would advise against us taking our dog to Dove Lewis from the 26th onward, especially since, as concurred by our consulting veterinarians, our dog was in need of crucial evaluations from the 26th onward.
(5b) Dr. Earp and Franklin referred us to Dr. Simpson on 2/26 for a surgery consultation. On 2/26 Earp and Franklin stated that the surgery would be to remove most or all of the sub-lumbar tumor, and, the anal gland tumor. They also stated that our dog would have a prognosis of “about a year”. Our consulting veterinarians argue that it was highly inappropriate for them to provide us with a prognosis without having done a full medical inquiry, which would have included, as a matter of minimal medical competence, doing a chest xray. Again, we speculate that this xray was intentionally not done in order to delay our knowledge of our dog’s condition until our meeting with Simpson on 2/29.
(5c) We did not receive a reply on the 26th about a referral appointment day and time. On the 27th in the afternoon, after we called Dr. Earp many times, we were given a referral for the 29th. We asked why our dog’s case wasn’t being treated as an emergency given the severe and escalating symptoms, and Earp, once again, doubted our reports of the severity of symptoms, saying that the xray (the 2/26 xray) “showed that the feces were moving”, and “I don’t understand the symptoms you’re reporting”, and then told us that “Dog’s can do well for many days without food”, which we found extremely strange because (a) there should have been someone available on the 27th or the 28th at the least, besides Dr. Simpson, for a surgical consultation; we asked about other surgeons and they strongly advised us against looking around for other surgeons, and said their referral was specifically to Dr. Simpson; and (b) our dog was rapidly loosing strength from lack of, and then absence of food since the 27th, and it would seem to me (I forgot to ask the consulting veterinarians about this) that it would be important to have surgery done relatively immediately. Dr. Simpson’s reason for the 29th appointment was that her office was booked until then.
(Aside: in our 2/29 appointment with Simpson, she said “They didn’t do a chest xray?” and showed substantial surprise and confusion about why they did not do this. Prior to Simpson doing a chest xray, she said that for surgery she wouldn’t be available until Monday 3/3. We were shocked and extremely confused at this, and asked if she could inform Earp and Franklin about this; our dog had stopped eating as of early 2/28 and Simpson was made aware of this at the outset of our appointment; Simpson seemed to not have any sense of care about what a delay to 3/3 would mean for our dog).
(6) Related: We called Franklin in the two weeks after our dog’s death for the purpose of having his assessment of how our dog’s medical care was handled by Earp. We had two approximately 10 minute conversations with him. One point we made was the importance of early diagnosis to us, for the purpose of planning for our dog’s prognosis, and/or death, as early as possible. We said that at the least, on the 26th, it appears very clear that all the relevant diagnostic information could have been obtained by having a competent rectal exam done, and then the warranted abdominal and chest x-rays. Instead, there was a total failure of competency by Earp on the 26th, and a failure to do the very obviously warranted chest x-ray on the 27th by Earp. He replied “The chest x-ray was my bad too; I didn’t think to do it.” He then continued by saying the following, and referring to our interest in early diagnosis: “It doesn’t help to know any earlier; it doesn’t make it any easier.” Similar to Earp, Franklin made comments that were outside of the sphere of veterinary medicine, comments that are reflections of his personal values rather than medical judgments; and it appears that Franklin, like Earp, let his personal values guide the way he was practicing medicine with us and our dog, from Earp and Franklin’s apparently intentional forgoing of the obviously warranted chest x-ray on 2/27, to their recommendation against and arguments against going to Dove Lewis for a surgical consultation, to their referral to a surgeon whose schedule wouldn’t permit an emergency appointment, nor surgery on the day of the consultation. It would seem that, given our dog’s case, surgery should have been planned for the 29th. The consulting veterinarians concur that when a dog has massive cancerous tumors and has stopped eating, stopped urinating, is shivering, in pain, has a stilted gait, etc, that surgery should be considered an emergency.
(7) Police matter.
Our two conversations with Franklin were rushed and abruptly ended by him due to his pending appointments. (In our first voice-mail exchange with Franklin, he said he was available to discuss things with us, and asked us to call him back. We did, and reached the receptionists, usually Marilyn and Sunny, and they both encouraged us to keep calling to try to reach him “between appointments”, which we did, often 5-8 times a day. Franklin was reported to us by Earp’s staff as Earp’s supervisor. Franklin would not set a phone appointment time or day, and he did not accept our offer to pay for an appointment to meet with him (and Earp if possible). After our second rushed telephone conversation, we decided to call Earp’s partner Dr. Lynn Eardman, and we left a simple voice-mail with her asking to discuss the matter with her in light of Franklin’s limited time. Several weeks later, as our discussion with friends and others grew, one of us (DT; initialed) emailed Earp with several objections, and Earp was also apparently emailed a few times by various parties objecting to his handling of our dog’s case. Earp reported DT to the Beaverton Police Department 503-526-2260, Officer White, who then contacted DT to express Earp’s complaints, which were that DT was “paying multiple personal visits to his office, making repeated personal phone calls, sending harassing emails, and that the email writing from several email addresses all seemed like DT's writing.” In fact, the last two office visits we made were on 2/28th for an appointment with he and Franklin, and then a week later to pick up the abdominal xray film, which is something we arranged in advance to pick up, and which consisted of DT having to wait 30 minutes for the xray to be produced, then within 1 minute Dan signed for the xray and left the office. Earp led the police to believe the DT was making persistent non-medical visits to his office. Further, all of the phone calls that were made were completely acceptable, including the phone calls over the week while we were waiting for the CD xray to be returned to Earp from Simpson’s office. We were awaiting Dr. Eardman’s reply, and having none, we discontinued calling there. Further, Earp led the police to believe all of the emails sent to his office were from DT.
The above issue about the xray film and CD xray is continued below in #8.
While this police matter is not directly related to our complaint, we have included it here to provide additional instances where Dr. Earp has been deceptive and dishonest. His office staff will attest to how our last two visits to his office were for the schedule appointment and to pick up the xray. They, and Franklin, should attest to the process involved in reaching Franklin by telephone, and how they all recommended us to keep calling to try to reach Franklin between appointments; Franklin should also attest to how he was amenable to a second phone call due to the first phone call being cut short; Franklin told us that he was available later to continue our discussion. He, also, called us several times and left several voice mails.
(8) The following is about the unreasonable delay of Earp’s office providing the xray film from 3/11 to 3/14, and about their failure to provide the CD film, and about the unreasonable in-office delay on the day the xray film was picked up.
The second series of phone calls to Earp’s office was made between 3/7-3/14. We called Earp’s office on 3/7 and 3/8, and several times up to 3/14, for the purpose of getting the CD of the chest xray sent to them by Simpson’s office on 3/6/09 in the morning, and for the purpose of getting the abdominal xray film taken by Earp and Franklin. These films, along with our dog’s medical records, were to be taken by us to oncologist Dr. Juliana Cyman’s office 503-644-6581 for her post hoc 2nd opinion on the nature and treatment of our dog’s condition. The CD chest xray was also to be received by Franklin (again whose office is adjacent to Earp’s in the same complex) for his post hoc review on the severity of the lung cancer; he asked us to request the CD for his analysis and told us he would call us with his analysis of it; in our second conversation with him in the second week of March, he said he reviewed the CD and was in agreement with Dr. Simpson’s decision to not do surgery and to advise euthanasia. He also said “if surgery would have been done, then you would have been calling me about how your dog was in so much pain over the 4-6 final weeks of life before the lung cancer and distress made euthanasia necessary.”
Earp’s office manager Marilyn called us on 3/14 to say that they could not find the CD in their files, nor Earp’s personal files, nor Franklin’s personal files, nor Franklin’s main office. We decided to request and pick up a copy of the CD from Simpson’s office on 3/14 in the early morning.
We called Earp on 3/11 in the early morning to schedule to pick up the xray film taken by he and Franklin. We were told it had to be located, and we were subjected to having to call 1-2 times a day from 3/11 through 3/14 in the morning due to the film not being located, and due to their unwillingness to update us daily on whether they found the film. We told them that we were needing to schedule an appointment with Cyman for 3/11 or soon after, and needed the film prior to making the appointment, and for the appointment. Earp’s office (Marilyn and Sunny) also told us to call daily if they forgot to call us. We received a call in the morning of 3/14 that it had been found. We then scheduled an appointment with Cyman for the afternoon of 3/14, and in the morning of 3/14 scheduled a time with Earp’s office manager Marilyn to pick up the film from Earp’s office later in the afternoon on the way to the appointment with Cyman. We scheduled a time of 3:00pm to pick up the xray, which is over five hours from when the appointment to pick up the xray was made between us and Marilyn. Marilyn was also informed by us that we were getting the film for our appointment with Cyman, and were under a deadline to get the film in order to meet the appointment. DT went to pick up the film, and needed it within 5 minutes or so in order to meet his schedule to meet with Cyman, and found that Marilyn and the other receptionist did not have it ready for him. DT was then subjected to waiting for over 30 minutes for Marilyn to get it, and he observed her asking several people where it was located, and observed her walking to the adjacent building through the connecting glass walk-way, and observed her having extended personally oriented conversations with two people. DT reiterated to she, and the other receptionist, that he had an appointment deadline with Cyman. The delay caused DT to miss his appointment by 15 minutes. DT gave himself 25 minutes to drive from Earp’s office to Cyman’s office (a 10 minute drive away), and planned to have the film within 1-5 minutes from Earp’s office, for which he only had to put his signature on a form with a list of other signatures for other people who signed out their films. Once the film envelope was brought to the receptionist desk, it took 10 seconds to sign for it and leave the office.
