Dr. Wendi Rankin
Dr. Charles Walls
Veterinary Medical Specialists
7121 Amador Plaza Road
Dublin, CA 94568
Cc: Dr. Dwight Gaudet, Dr. George Marmalejo, Dr. Kevin Allen, Sonia Davis, Aimee Harris, Joe Salvador, Gena Austin, Pug Rescue Bay to Borders, PETA, ASPCA, CA Better Business Bureau, CA Veterinary Medical Board
Dr. Rankin and Dr. Walls:
It is extremely difficult for me to find the words that adequately express my feelings related to the death of my sweet boy and cherished member of our family, Wally on August 19, 2010 while under your care at Veterinary Medical Specialists. However, in honor of Wally’s memory and in defense of all animals and their families who face our situation and the choices with which I was presented by you, I am sending you this letter.
I visited our family veterinarian, Dr. George Marmalejo, on Monday, August 2, 2010 to look at a lump on Wally’s left hind leg. My partner Nilo and I discovered it at home while playing with Wally and I was concerned about it. Dr. Marmalejo thought that the lump might have been a sebaceous cyst but took an aspirate of it for testing. He contacted my partner Nilo and me on Wednesday night, August 4, 2010 to let us know that the lump was indeed a mast cell tumor. He was unable to tell me what the stage or the grade of the tumor was at that point. However, he had contacted Dr. Charles Walls at Veterinary Surgical Associates located within your office, to discuss removal of the tumor. Dr. Marmalejo made an appointment for us with Dr. Walls for surgical removal of the tumor on Monday, August 9, 2010 at 10:00AM. We fasted Wally the night before and I brought him to your facility on Monday morning.
After meeting with Dr. Walls and his examination of the tumor, he notified me that the tumor was too large in its then present state to remove. He went on to say that the lump was not “all tumor”; it more than likely contained other material and irritants. Dr. Walls said that the tumor would have to be reduced in size and was recommending a period of prednisone along with the possibility of radiation to shrink the tumor so it could be surgically removed. Because Dr. Marmalejo had started Wally on baby aspirin the prior week for what I thought was arthritis, Dr. Walls indicated we could not start the prednisone that day because it was contraindicated with aspirin. Rather, he prescribed Misoprostol for Wally and said that we needed a referral with the oncologist. Dr. Marmalejo had suggested to Dr. Walls another member of your organization, Dr, Jakubiak, for the oncology referral. I was told that he was located in Concord but that you were the oncologist in Dublin, CA location. Since the surgery was to be performed in Dublin, I saw no reason why we should not see you. We made an appointment for the following day, August 10, 2010 for a consultation with you.
I brought Wally back the next day for our consultation. When we were being brought to the examination room, your nurse Gina told me that you would be talking to me about chemotherapy for Wally. Chemotherapy, I asked? I told her that Dr. Walls indicated radiation. She had no reply.
After your examination of Wally, you met with me and confirmed that it was a mast cell tumor, that Wally would need an ultrasound to rule out spread and that you wanted to treat the tumor with a combination of a drug called Vinblastin along with Prednisone. I was shocked. My mother died of small cell lung cancer and I know how toxic chemotherapy is; I expressed that concern to you. This was the only option for treatment with which I was presented. I asked you the following questions which you answered:
Q. Could we proceed with radiation treatment instead of chemotherapy and prednisone?
A. Radiation could damage the tissue around the tumor and make surgery much more difficult if not impossible.
Q. Dr. Marmalejo talked about a lumpectomy. Could we do a lumpectomy?
A. A lumpectomy on a tumor with dirty margins as this tumor exhibited would be likely to leave behind cancerous tissue after a lumpectomy. Sewing cancerous tissue to cancerous tissue in closing the skin could cause serious issues going forward.
Q. Friends had suggested that I consider amputating the leg.
A. Amputation was an “extreme measure” (your words). You told me that the treatment protocol you were suggesting had a great success rate and that I should not consider such an extreme option as amputation at that point in time. I ask you today, is amputation more extreme than death?
You explained to me that animals did not react to chemotherapy the same way that people did. In people, you explained, chemotherapy is used to kill the cancer and is used in much higher doses. In animals, much smaller doses are used to control the cancer’s spread. You told me that “80% of animals have little to no side effects from chemotherapy”. You further indicated that “20% of animals experience side effects including vomiting, drooling and diarrhea sometimes requiring hospitalization”. You prescribed Metroclopramide to combat these side effects. I asked you that if I consented to chemotherapy, did I need to keep Wally at home, segregated from other dogs and places, to ensure that his immune system was not exposed to any unnecessary bacteria. You told me that would not be necessary and gave me every reason to believe that this protocol was safe and the best possible option for Wally. At no time during our consultation did you ever mention that this protocol could lead to a catastrophic failure of Wally’s immune system causing sepsis that would lead to his death. You never ever mentioned that this protocol could kill him. It was never a fact that I had to consider before consenting to this treatment.
I consented to the chemotherapy and you indicated that it would be performed after the ultrasound. I decided to wait rather than go home despite the fact I was told it could be up to three hours. I walked to the Starbucks around the corner. Within minutes, I received a call from Gina, your nurse, telling me that Wally was very agitated and needed sedation for the ultrasound and chemotherapy. I reminded Gina that I told you Wally was an abused dog before he came into our home and he had a distrust of vets and anyone who he did not implicitly trust. I reluctantly agreed to allow you to sedate him. When I returned and met with you again, you indicated that the ultrasound was clear, that there was a second suspicious tumor in the same area and that the tumor was close to his lymph node which you attempted to aspirate but could not. You recommended that lymph node be removed during surgery. You indicated that Wally may appear groggy the rest of the day as a result of the sedation but that this would wear off in 12-24 hours. It did not. 36 hours later, Wally could still barely stand up on his hind legs and appeared catatonic. I contacted your office and reached someone who was filling in as your nurse that day. She was surprised that Wally was still exhibiting these symptoms almost two full days later. She pulled his chart and told me that you used a heavier dose of sedation on him than you normally would have because of his agitation and because it was already late in the afternoon (our appointment was at 1:00PM) and that you needed to ensure that he could receive the treatment in the time allotted. I was obviously very distressed to learn this. When you contacted me a few hours later, you assured me that he would snap out of it. I told you that I did not want him sedated again for any treatments other than the surgery. You indicated that there were other sedations available that could be administered with a “reversing agent” that would bring him out of it. I agreed that I would consider this option when I returned for what was to be his second treatment on Tuesday, August 17, 2010.
When we arrived on Tuesday, August 17, 2010 for our 8:00AM appointment, I was elated to learn that the tumor had shrunk by 50%, that no more chemotherapy would be necessary that day and that we could schedule surgery for Tuesday, August 24, 2010. You indicated that we needed to wean Wally off the prednisone before surgery. I left with a written instruction (not verbal) that if I noticed any sign of infection, I needed to contact you right away. I was not sent home with any prophylactic antibiotics to treat any potential for infection. In retrospect, I do not understand why not. I know that you said treating all animals on chemotherapy with antibiotics could lead to antibiotic resistant bacteria; but why would you not put a senior dog with missing teeth on an antibiotic when you said that one of the transmission points for sepsis was dental? Wouldn’t he have benefitted from an antibiotic?
Wally and I returned home. We had dinner, watched TV, played with his older brother Niko and went to bed by 9:00PM. We were happy…for the last time as it turned out. Wally sleeps in our bed with my partner Nilo and I and when he went to bed, he was fine. At 2:30AM, Wally woke us up gasping to breathe. His tail was down and he was clearly in distress. I rushed him back to your complex and he was seen at Tri Valley Animal Hospital in your building at approximately 3:15AM by Dr. Kevin Allen. Dr. Allen took an x-ray, examined him and said although the x-ray did not indicate pneumonia, it was suspicious for pneumonia since he was clearly having trouble breathing and he had a fever of 104.3. He was admitted at that time, put on oxygen and intravenous antibiotics.
I came to visit him later that afternoon and he was still struggling to breathe. He had not urinated all day despite the amount of fluids being given to him intravenously. I was allowed to take him outside to see if I could get him to urinate. He did not. In fact, he just stood there and then fell on his side. I brought him back in and we returned him to the oxygen area. You did not consult with me in person while I was there that day but called me later and continued to state that he had pneumonia. I did not know at the time that the diagnosis of pneumonia was not confirmed by your colleague, Dr Clooten, because the chest x-ray remained inconclusive for pneumonia. Was he being treated with antibiotics for pneumonia only? You mentioned there was a third antibiotic that was of the same class. Would it have helped had we acknowledged at the time that Wally had sepsis and no pneumonia? I will never know. I also told you that I was concerned that he had not urinated all day and was worried that he may suffocate with all the fluid in with no fluid out. You indicated that a catheter had been inserted and that it was catching “some urine”.
At 10:00PM that night, Dr. Allen called me expressing serious concern about his breathing, his blood pressure, his sugar and the fact that it appeared he was in kidney failure. Despite the catheter you had inserted, he was still not urinating. Hi creatinine level was still high as it was all day indicating that his kidneys were shutting down. Dr. Allen was the first person to ever say that Wally had sepsis. Dr. Allen started Wally on Lasix immediately as well as Dopamine for his blood pressure and glucose for his sugar. He was able to get his kidneys working again, stabilized his blood pressure and sugar and his fever remained low. These were all good indications that Wally was moving in the right direction. Dr. Allen called me at the end of his shift on Thursday morning to let me know where we were but also advised me that Wally was still very sick but that all of the numbers were moving the way we wanted them too. I was cautiously optimistic. You called me about an hour after Dr. Allen when you completed your rounds and reiterated all of what Dr. Allen told me and said that Wally creatinine level was still high and his breathing had not improved.
I arrived at VSA on Thursday, August 19, 2010 at approximately 2:30PM. I asked if I could take Wally out of the oxygen area and hold him as I did the day before. Gina indicated that you said I could not. When I saw him, it was clear to me why; his breathing was still disturbingly labored. He looked exhausted. His eyes were open and although he was responsive to my petting him, his breathing was shallow and heavy. I pet him for about 35-40 minutes and was then encouraged to meet with you. You indicated that Wally was not improving and that due to his labored breathing he would need to be placed on a ventilator that night or in the early morning. You indicated that he was failing and that he had less than a 5% chance of recovery even if we put him on the ventilator. His fever started to rise again despite the Ampicillin and Baytril he was receiving. This was the first and only time that you acknowledged that Wally had sepsis and that this type of catastrophic infection happens in 5% of the animals receiving this protocol. You stated that it was not unrealistic to consider euthanasia at this point in Wally’s illness. Unrealistic? Wally is a member of our family. I could not love him more if he was my child and you were telling me that it was not unrealistic to consider euthanasia! You never told me that this could happen just 8 days ago when I met you and now it was not unrealistic to end my dog’s life!
My partner Nilo Ventura came along with Wally’s foster parents upon his rescue, Rex Winchester and Tony Tiu, to help me. You explained the situation again and left the room for us to talk. Wally was clearly suffering, undeservedly so. After hearing you out, I decided, with the help and guidance of my partner and friends, that I could not subject Wally to a ventilator and more intervention if he had less than a 5% chance of survival with that intervention. As his temperature continued to rise over 105 degrees and because Wally was so deeply loved and having him continue suffering was unbearable, it forced the euthanasia decision as the only horrible choice to end what your actions had started. Reluctantly, horrifically, I consented to let you euthanize him. We all said good bye, hugged him, cried and held him as you administered the lethal injection that ended his life. Wally died Thursday, August 19, 2010 at approximately 3:45PM exactly 9 days after he walked through your door seemingly healthy and happy despite the fact he had this mast cell tumor with which I now understand he could have lived with for a number of years.
I find it incredibly painful and difficult to relive all of this. I find it more difficult to live with the fact that this did not have to happen. I learned after Wally’s death that a less aggressive treatment of prednisone only was available to try to shrink Wally’s tumor. Neither you nor Dr. Walls ever presented this approach to me; not once, not ever. I had no idea that I could put him on “pred” initially and that there was a good chance it could shrink the tumor. In fact, it appears from all that I read, prednisone is a perfectly appropriate treatment to shrink mast cell tumors. Yet, neither of you ever offered it as an option. Why? I know now that it was not a perfect option. I know now that prednisone only would have shrunk the tumor but not necessarily kill all of the cancer cells. I know now that had we gone that route, there would have been remaining cells that could have been dealt with using RCT. I know all of this because I sit up at night reading about it all because I cannot sleep; both you and Dr. Walls had an obligation to share this information with me so that it would be my decision as to what was the best for Wally, not yours. Had we tried that first, Wally would be sitting here next to me right now rather than in your freezer waiting to be picked up by the crematory. Why? Was it the money? What would you have prescribed had I not had the money for the treatment protocol you recommended? Would you still have proceeded or would you have prescribed prednisone? It kills me to think that Wally was subject to a life threatening protocol because I was in the unfortunate position to afford it. I hope and pray that this is not the case. It kills me to think that neither of you ever offered prednisone only as an alternative. I wish that I had said no to your protocol. I wish that I did not trust you and your judgment. It kills me to think that you could have said that I should take some time to think about the treatment recommendation. I will forever blame myself for bringing him to your office. I will forever blame myself for trusting you. However, I will forever blame both of you, Dr. Rankin and Dr. Walls, for not giving me all of the information about the protocol you were recommending and the valid alternatives to the chemotherapy. I feel that your actions were based on arrogance. It is clear that you have had success with the Vinblastin/Prednisone therapy. I believe that it was your collective arrogance that this therapy would work that led you not to share the risks associated with it---all the risks, including the fact that it could kill him.
I am enclosing a picture of Wally and me for you. I would like for you to keep it and look at it every time you meet a family that is facing what we faced. Look at it and know that by failing to disclose all of the facts, all of the possibilities, all of the risks in a true and upfront manner you fail to offer the family what they need to make a decision that they will have to live with for the rest of their lives. I will never know if I was presented with a “pred” only approach if I would have taken that initially. I will never have that chance because the option was not made available. You took that opportunity away from me and it cost Wally his life and will cause me to forever wonder “what if” in relation to all the decisions I made. I am also enclosing a copy of the tribute I wrote for Wally on Friday morning, the day after he died. I encourage you to read it. You will learn about this noble, loving soul that no longer lives in our house, that no longer plays with his brother and no longer snuggles and kisses Nilo and me. You will learn about the horrible conditions he lived in before he was rescued and all that he overcame as he brought nothing but unconditional love and happiness to everyone who met him. You will learn how you have shattered our hearts and changed our family forever. I will never forgive myself for what I allowed to happen to Wally despite everyone’s admonition that I was acting in Wally’s best interests. I will never forgive either of you for not presenting all the options for his treatment and all the facts about the dangers associated with the protocol you recommended regardless of how “rare” these dangers were; the rarity of these dangers is of little comfort to me and my family now.
Unfortunately, our legal system considers pets’ property. Veterinary negligence and malpractice often goes unpunished because it is not “profitable” for lawyers to pursue. I find that regrettable. However, I want to ensure that no family has to endure what we have endured. A copy of this letter will append my formal complaint to the Veterinary Medical Board. The complaint will accurately state that I was not made aware that a less aggressive, equally effective in many cases, less expensive protocol of oral prednisone and injections was never presented as an option for Wally’s treatment. The complaint will further state that you never advised me that the Vinblastin-Prednisone protocol could kill Wally. Regardless of how remote you considered that a possibility, it was still a possibility and you should have told me so I could make the decision, not you. You robbed me of that opportunity.
To add insult to injury, I learned that almost one week after Wally’s death, his body is still stored in your freezer. When he died, Gina indicated that his body would be picked up in the “next day or two” by Animal Memorial Service in Gilroy for cremation. I learned on Monday that he would not be picked up until Wednesday, almost a full week after he died, because that is the “schedule”. Have I spared any expense in caring for my sweet boy? I would certainly paid extra to have Wally picked up the next day rather than have him sit in a freezer for a week. Yet, this was never offered as an alternative for us. I find that callous and cold.
I no longer trust those in your profession. I will find it difficult to trust another vet to intervene on any animal in my care beyond the most minimal effort. There are no consequences for what you do, especially when you do it wrong. There is only the heartbreak of the families that you leave behind in your wake and the lost family members who no longer grace the earth with their innocence, unwavering trust in their humans and their unconditional love.
With profound regret,
Thomas John Bauer
