Rachael Khare DVM Disciplined By Vet Board

July 27, 2022

VIA CERTIFIED MAIL

Re: Complaint No. 2022003-8
Lewis German

Dear Dr. Khare:

Board Investigative Procedure

Summary of Complaint - Received 01/06/22

Mr. German's complaint, received January 6, 2022, is summarized as follows:

• On December 10, 2021, Mr. German presented Koal, an 11-year-old male Tibetan Mastiff, to you for a slip and fall resulting in dragging his rear legs. You gave Koal a chiropractic adjustment and recommended four (4) acupuncture treatments. At home, Koal was dragging one or both rear legs some of the time. He was able to lay down and get up without much difficulty.
• On December 27, 2021 , Mr. German presented Koal for chiropractic adjustment and acupuncture but only received acupuncture. Koal did not attempt to get out of the vehicle and you administered acupuncture in the car. You placed five needles in Koal's back, one in his left leg and one in his neck. An assistant removed them 15 minutes later. You did not examine Koal.
• You also examined Koal's stool sample. Mr. German reported Koal had stopped eating. Mr. German also explained an online vet suggested Oxycodone, but you did not agree with giving Koal that medication. When Mr. German asked for bloodwork to be done, he was told he had only booked a 15-minute appointment. You suggested Mr. German bring Koal back the following Friday for another appointment to examine him and obtain bloodwork.
• Koal was unable to get out of the vehicle when they arrived home. Mr. German took Koal to an emergency vet when he realized Koal could not move. Koal stopped breathing while waiting to be seen by the emergency vet.

Response of Rachelle M. Khare. DVM - Received on 02/14/22

Your response to Mr. German's complaint was received on February 14, 2022, and is summarized as follows:

• On December 10, 2021, Mr. German presented Koal for slip and fall resulting in dragging his rear leg. Koal's physical examination revealed bilateral stifle thickening and crepitus with decreased range of motion, hind leg weakness and right rear lameness with intermittent knuckling. You could not rule out CCL. Mr. German reported Koal seemed to be in pain.
• You recommended manipulation and acupuncture. At that visit, Mr. German chose to proceed with manipulation rather than acupuncture because it was difficult to bring Koal to the vet weekly. Radiographs were advised but not taken and recommended at the next visit if there was no improvement. You increased Koal's Gabapentin and recommended Galliprant.
• On December 20, 2021, Mr. German called to advise prior medication injections (given on November 15, 2021 by Dr. Lathan at Whole Pet Veterinary Hospital) did not help. Mr. German spoke with a receptionist and Dr. Lathan.
• On December 27, 2021, Mr. German presented Koal for acupuncture treatment. Mr. German arrived over half an hour late. Koal was not eating and had diarrhea. Koal was not able to get out of the vehicle; therefore, you performed acupuncture in the vehicle. Mr. German reported Koal was not eating and had runny diarrhea. You explained the diarrhea could be from his diet, the new Oxycodone medication or some other reason. You recommended that Mr. German stop giving Koal Oxycodone because it is not formulated for dogs and a veterinarian did not prescribe it. You offered labs and an exam at the beginning of the treatment, but it was declined. You performed acupuncture treatment.
• A veterinary technician removed the needles 15 minutes later. Mr. German requested a full examination and bloodwork. Mr. German was advised he would have to be worked in and a doctor's exam fee would be assessed. Mr. German declined and asked for prescriptions.
• You advised not to give Koal human medication as it is not formulated for animals and to stop giving Oxycodone. You prescribed nausea medication, refilled Metronidazole, continued Galliprant and recommended 400mg of Gabapentin two times per day. If Koal did not improve in 24 to 48 hours, you advised making another appointment for full exam and work up.
• You stated Koal had a chronic history of lameness and limping, and suspect Koal had more than an orthopedic injury that led to his passing.

Reply from Lewis German - Received on 03/01/22

Mr. German's reply letter was received on March 1, 2022, and is summarized as follows:

• Mr. German contends he did not deprive Koal of treatment. He tried to make an appointment before Christmas but could not.
• Mr. German contends the appointment on December 27, 2021 was at 2:00 p.m. and it was for both acupuncture and chiropractic adjustment. This was a follow-up appointment for his acute back injury. You did not examine Koal's spine. You placed five needles in his back, one in his left leg, and one in his neck. When Mr. German asked for full exam and bloodwork, you did not offer to work him in but only offered to schedule a future exam.
• Mr. German contends that when he told you Koal was knuckling on both rear feet, you had no follow up questions or comments and made no recommendations for radiology. You suggested Koal had mobility issues and was shifting his weight during exam. Koal was unable to shift his weight because he could not move his legs. You refused treatment when you declined to draw his blood.

Second Response of Rachelle M. Khare, DVM - Received on 03/16/22

Your second response letter was received on March 16, 2022, and is summarized as follows:

• Tiffany Docetti, a veterinary technician, entered client communication that described Mr. German's request for bloodwork after acupuncture on December 27, 2021. You did not make that entry. Ms. Docetti told Mr. German they could do bloodwork, but Koal would have to be worked in and charged the exam fee because the appointment was only scheduled as an acupuncture visit. Mr. German stated he would call back to schedule the bloodwork appointment. You contend all records and statements are factual.
• You contend that no neurological deficits were noted in previous exams. Had there been an abnormal neurological exam, a referral for neurology and MRI would have been made. Any spinal manipulation would have been declined without radiographs and exam.

Letter from Mary Hunter - Received on 3/17/22

Mr. German's wife, Mary Hunter, submitted a letter on March 17, 2022 confirming the allegations of the Complaint and alleging you misdiagnosed Koal. Ms. Hunter states it appears Koal had a more severe back injury involving a form of degenerative myelopathy.

Interview with Dr. Khare on 07/06/22

On July 6, 2022, you appeared before the Committee to discuss Mr. German's complaint and your treatment of Koal.

Decision of Committee on Investigations No. 8

The members of Committee on Investigations No. 8 evaluated and discussed the information in this file to determine whether there is probable cause of a violation by you of the N.C. Veterinary Practice Act or Board Rules on the issues presented.

The Committee finds and decides:

1. You did not diagnose Koal's condition before you performed spinal manipulation and acupuncture, which was error. Obtaining a diagnosis before rendering treatment is imperative. While it appears your clinic may have a practice of scheduling patients for treatment before a definitive diagnosis is obtained, the decision about whether to render treatment is ultimately yours as the treating veterinarian, and any treatment must be supported by a diagnosis.
2. Given plaintiff's presenting condition on December 10, 2021, which included crepitus and thickening in the stifles with right rear lameness, limping, apparent pain and possible CCL, you should have recommended radiographs on that day, as opposed to performing spinal manipulation and recommending radiographs at a later date if Koal did not improve. Radiographs would have assisted in obtaining an accurate diagnosis.
3. Similarly, on December 27, 2022, you should not have treated Koal by performing acupuncture without first making a diagnosis, which would have required radiographs.
4. In addition, when Koal presented on December 27, 2022, with dark stool and diarrhea, you should have obtained bloodwork and performed a physical examination and fecal examination before prescribing medication to Koal.
5. N.C.G.S. 61 .0207(b)(12)(A) states: "Every veterinarian shall keep written records or records stored via computer/word processing and easily retrievable of the animals treated. These records shall include but not be limited to pertinent medical data such as dates and type of vaccinations and all medical and surgical procedures on a daily basis, radiographs and laboratory data." While you have asserted that you made recommendations to obtain radiographs and bloodwork, which were declined by the owners, your medical records should have reflected the recommendations you made.

Accordingly, although there is no probable cause of a violation of the N.C. Veterinary Practice Act and dismissal is proper, the Committee has issued this Letter of Caution because your conduct detailed above is not in accord with accepted professional practice and may be subject to discipline if continued or repeated.

The Board has accepted the Committee's findings and decision. The investigation is complete, and the file is closed.

If you have questions about the decision or this letter, please contact the Executive Director of the Board, Tod J. Schadler, DVM.

The Committee expresses the sympathy of the Board to Mr. German for Koal's passing.

cc:   Mr. Lewis German

Board Members

Tod J. Schadler, DVM, Executive Director

SECTION .0600 - ADMINISTRATIVE HEARINGS: PROCEDURES

21 NCAC 66.0601   COMMITTEE ON INVESTIGATIONS

(a) Upon receipt of a charge alleging misconduct against a licensee or registrant of the Board, the Executive Director shall inform the accused party of the nature of the charges as filed with the Board.

(b) The accused party shall respond to the charges by filing a written answer with the Board within 20 days of the receipt of the notification of charges.

(c) The complaining party shall be provided with a copy of the accused party's answer and within 20 days from receipt thereof shall file a reply to the accused party's answer.

(d) The charges as filed with the Board, the answer and reply may be referred to the Committee on Investigations (hereinafter referred to as "Committee"). The Committee shall consist of three members of the Board, one of whom shall serve as chairman.

(e) The Committee shall investigate the complaint referred to it by the Board and as part of the investigation may:
(1)   Assign the complaint to the Board's investigator who shall submit a written report to the Committee.
(2)   Invite the complaining party and the accused party before the Committee to receive their oral statements, but neither party shall be compelled to attend.
(3)   Conduct any other type of investigation as is deemed appropriate by the Committee.

(f) Upon the completion of the investigation, the Committee shall determine whether or not there is probable cause to believe that the accused party has violated any standard of misconduct which would justify a disciplinary hearing based upon the grounds as specified in Article 11 of Chapter 90 of the North Carolina General Statutes or this Chapter.

(g) If probable cause is found, the Committee shall direct the legal counsel for the Board to file a Notice of Hearing.

(h) If probable cause is found, but it is determined that a disciplinary hearing is not warranted, the Committee may issue a reprimand to the accused party. A statement of such reprimand shall be mailed to the accused party. Within 15 days after receipt of the reprimand, the accused party may refuse the reprimand and request that Notice of Hearing be issued pursuant to Chapter 1508 of the North Carolina General Statutes or this Chapter. Such refusal and request shall be addressed to the Committee and filed with the Executive Director for the Board. The legal counsel for the Board shall thereafter prepare and file a Notice of Hearing. If the letter of reprimand is accepted, a record of the reprimand shall be maintained in the office of the Board.

(i) If no probable cause is found, the Committee shall dismiss the charges and prepare a statement of the reasons therefore which shall be mailed to the accused party and the complaining party.

(j) If no probable cause is found, but it is determined by the Committee that the conduct of the accused party is not in accord with accepted professional practice or may be the subject of discipline if continued or repeated, the Committee may issue a letter of caution to the accused party stating that the conduct, while not the basis for a disciplinary hearing, is not professionally acceptable or may be the basis for a disciplinary hearing if repeated. A record of such letter of caution shall be maintained in the office of the Board.

(k) A Board member who has served on the Committee is deemed disqualified to act as a presiding officer or member of the Board assigned to render a decision in any administrative disciplinary proceeding brought pursuant to a Notice of Hearing for which that member has sat in an investigative capacity as a member or chairman of the Committee.

(l) The Board may assess and recover against persons holding licenses, limited licenses, temporary permits, faculty certificates, Zoo veterinary certificates or any certificates of registration issued by the Board, costs incurred by the Board for the following expenses, respectively, that have been incurred by the Board in the investigation, prosecution, hearing or other administrative action in final decisions or orders where those persons are found to have violated the Veterinary Practice Act or Administrative Rules of the Board:
(1)   legal expenses, including reasonable attorney fees, incurred by the Board; and
(2)   witness fees and statutorily-allowed expenses for witnesses; and
(3)   direct costs of the Board in taking or obtaining of depositions of witnesses; and
(4)   costs incurred by reason of administrative or staff time of employees of the Board directly attributable to the action leading to the final decision or order.
The costs assessed may be assessed pursuant to final decision or orders entered with or without the consent of the person holding the respective license, registration permit or certificate; no costs referred to in this Paragraph shall be assessed against a person holding a respective license, permit registration or certificate for an investigation or action in the nature of disciplinary action other than a final decision or order of the Board, unless and except expressly consented to by said person in a Consent Order approved by the Board.

(m) A civil monetary penalty of up to five thousand dollars ($5,000) for each violation of Article 11, G.S. 90 or Board rule may be imposed and collected from a person holding a license (the word "license" is as defined in G.S. 90-187.&(a)) upon a finding by the Board of the relevant factor or factors in G.S. 90-187.&(b)(I) through (6). With respect to this subsection, the phrase "violation of Article 11 , G.S. 90 or Board rule" shall be deemed to mean Article 11 , G.S. 90, the Veterinary Practice Act, or the rules of the Board, and shall include final decisions, orders, and consent orders, letters of reprimand and other permitted disciplinary actions, but it expressly excludes letters of caution issued by the Board.

History Note:   Authority G.S. 90-185(3); 90-185(6);

Eff. January 1, 1987;

Amended Eff. May 1, 1996, May 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

2024