Veterinary Expert Opinion #2

Veterinary Expert Opinion

I have been asked to render an opinion regarding the veterinary care of JoJo, a 14 year old
intact male Jack Russell Terrier owned by Mr. Dxxxxxx. I reviewed the following
materials provided by the owner to arrive at my opinion: Dr. Sheryl Fulop’s written
medical records and Dr. Goldman’s written medical records, which included a clinical summary,
physical examination, treatment plan, cytology results, 2 view radiographs, as well as Mr
Dxxxxxx summary of events. On 10/06/22 JoJo was seen by Dr. Goldman, of Agoura Hills
Animal Hospital in Agoura Hills, CA as a referral from a mobile veterinarian, Dr. Sheryl Fulop.
JoJo was seen on 10/05/22 by Dr. Fulop at JoJo’s home. According to Dr. Fulop’s medical
notes, she was called to the home because JoJo had not been swimming for 2 weeks, seemed
weaker, and had trouble walking. Blood work and whole body radiographs were recommended.
According to Agoura Hills Animal Hospital’s medical notes, “O says this started 8 weeks ago, O
think P had a seizure, O says P fell over and it lasted 10 seconds.” Dr. Goldman’s physical
exam notes state pale mucous membranes, a SQ (subcutaneous) lump above rectum, and
heart murmur 4/6. Two view radiographs were taken of the thorax and the cranial abdomen is
also visible. The record states the findings as “cardiomegaly (enlarged heart) and hepatomegaly
(enlarged liver). The record also states that JoJo was mildly anemic with an in house Packed
Cell Volume (PCV) of 32% (reference range 35%-55%). A senior screen and cystocentesis
collection (urine collection) was done and sent to an outside laboratory. It is documented in the
chart that JoJo was dispensed Pimobendan, an FDA-approved medication for Congestive Heart
Failure in dogs. On the morning of 10/07/22, JoJo passed away at the owner’s home.
Based on my 18 years of training and experience, medical references, and the preceding
information, implementing generally accepted methodologies and theories, I am prepared to
give my professional opinion on a more probable than not basis and with a reasonable degree
of medical certainty. Therefore, all views presented in this declaration possess at least this degree of confidence
unless otherwise stated.

Dr. Goldman’s physical exam notes report that a heart murmur of 4/6 was auscultated and his
mucous membranes were pale. Dr. Goldman’s medical notes also report a diagnosis of
cardiomegaly from the radiograph. Dr. Goldman then prescribed pimobendan, a drug commonly
used for severe heart disease or congestive heart failure. Based on the signalment of the pet (age, breed, and sex), the previously mentioned physical exam findings, radiographic interpretation in Dr. Goldman’s notes, and my own interpretation of the provided radiographs, I believe that JoJo could have been in Congestive Heart Failure. The thoracic radiographs were available for interpretation. Two views were taken and included a right lateral view and a ventrodorsal view (the ventrodorsal view I was provided was too small for accurate viewing of pulmonary vasculature or pulmonary parenchyma but the heart was able to be viewed clearly). There was no left lateral view in the records that were obtained. It is the medical standard to obtain three views (Left Lateral, Right Lateral, and Ventrodorsal or Dorsoventral projections) when taking survey radiographs.

Although my own interpretation of the radiographs provided agreed with Dr. Goldman’s finding of cardiomegaly, I also believe an interstitial pattern in the caudodorsal lung lobes on the lateral projection is present and likely consistent with cardiogenic pulmonary edema. Because it is a medical standard to obtain three views I believe Dr. Goldman’s ability to interpret the radiographs appropriately was negligent and may have affected JoJo’s diagnosis, resulting in insufficient treatment, and contributing to JoJo’s death.

Furthermore, even if Dr. Goldman did not believe it was congestive heart failure affecting JoJo,
both Dr. Fulop’s and Dr. Goldman’s records indicate that JoJo’s mucous membranes were pale.
Pale mucous membranes are a sign of a patient in critical condition and the cause of this
condition needs to be identified and treated immediately. Delay in treatment of pale mucous
membranes can result in death of the patient. Although a PCV (packed cell volume) was done
and revealed mild anemia, and further blood work was sent to an outside laboratory, medical
therapy and further diagnostics such as an abdominal ultrasound and complete abdominal
radiographs should have been performed to immediately help this patient. If this medical care
could not have been provided by Agoura Hills Animal Hospital then a recommendation to refer
to another practice should have been made. In the Agoura Hills Animal Hospital records
provided, no further diagnostics or referral recommendations were made to further diagnose or
treat JoJo’s pale mucous membrane color.

Therefore, I feel that Dr. Goldman’s failure to recognize the clinical significance of JoJo’s pale
mucous membranes delayed treatment of JoJo’s critical condition, resulting in the death of the
patient and medical malpractice.

Additionally, Mr Dxxxxxx states in his account of events that Dr. Goldman did not discuss
performing the fine needle aspirate of the rectal mass with him and did not have his consent to
do so. Additionally, there is no documentation of Dr. Goldman’s recommendation for this
procedure or that Mr. Dxxxxxxxx consented to the fine needle aspirate.
Based on my review, I, Tiffany Paul, affirm under penalty of perjury that Dr. Goldman, who
provided veterinary services to JoJo as described in this statement of facts and professional
medical opinion, did not adhere to the standard of care required of veterinary practitioners in the
nature described. My opinion is subject to change if additional medical records are provided.
Sincerely,
Dr. Tiffany Paul, DVM
10/23/22