November 14, 2003
The National Academies
Committee on the Review of the Smithsonian Institution's National Zoological Park
Board on Agriculture and Natural Resources
500 Fifth Street, NW
Washington, DC 20001
Dear Committee Members:
I have been the Associate Pathologist at the National Zoological Park since September 1991. But my association with the Zoo dates back to 1982 when I spent the summer between my 2nd and 3rd years of veterinary school working in the Department of Pathology at the Zoo. Following graduation from veterinary school, I completed a 2-year residency in veterinary pathology at the Zoo (July 1984 June 1986). After that, I was a Smithsonian Institution Post-doctoral Fellow from July 1986 through December 1987, which I spent in the Zoo's Department of Pathology and at the Conservation and Research Center. Thus, I have spent nearly 16 of the past 21 years working at the National Zoo.
I used to be very proud to tell people that I worked for the National Zoo because it was one of the best zoos in the country and had a stellar reputation as a leader in zoological research and conservation biology. However, during the last three years, the reputation of the zoo has been greatly tarnished. Much of this can be directly attributed to the controversial decisions and inept leadership of Zoo Director Lucy Spelman. Most disturbing of all is that, because of incompetence in management and veterinary medicine, the operations of the National Zoo have been in such a state of disarray that it has led to poor animal care, animal suffering, and even animal deaths.
As you all know, revelations of apparent animal mismanagement and veterinary incompetence by the media led to the formation of your committee to look into the animal care at the Zoo. My purpose in writing you this letter is to provide you with background information to aide in this investigation.
Let me begin by discussing the credentials of Lucy Spelman. Spelman came to the National Zoo in 1995 to serve as the associate clinical veterinarian under Dr. Richard Cambre, the head veterinarian. Although she had relatively little experience actually working in a zoo, Spelman had recently become "board-certified" in zoological medicine prior to her arrival at the National Zoo. It was not long before Spelman's lack of veterinary experience and her poor diagnostic abilities became quite noticeable to me. But I assumed she would improve as she gained more experience, and I felt that as long as she had a veteran zoo veterinarian such as Dr. Cambre overseeing her actions, things would be tolerable. However, after Dr. Cambre left in 1999 and Spelman was appointed head veterinarian that fall, I predicted there would be major problems with the quality of veterinary care for the zoo animal collection (although I never envisioned anything as bad as the cases I have discovered and will discuss below).
Following the death of a Grevy's zebra at the Zoo on February 1, 2000 (for details see Case #1 below), Assistant Curator Lisa Stevens and I were ordered to conduct an investigation of the circumstances that led to this animal's death. This order was relayed to us by the head of Animal Programs, Dr. Ben Beck, and he said it came from the Director's office. The reason that Lisa Stevens and I were chosen to do this was primarily because we were both on the Zoo's Institutional Animal Care and Use Committee (IACUC). What we discovered during this investigation was very disturbing: poor animal care at many levels, including veterinary care by Spelman. A report of our findings was distributed to Dr. Beck, Director Robinson, and Deputy Director McKinley Hudson. A few weeks later, I also provided a copy of the report to Mr. Richard Otto who was conducting his own investigation of the zebra's death for the Smithsonian Institution's Office of the Inspector General.
The IACUC report clearly stated that the death of the zebra was due to many failures in provision of adequate animal care, and that a reduction in the zebra's diet, which was ordered by Spelman, was a major factor in the animal's death. However, it soon became obvious to me that the Zoo's administration was not going to reprimand Spelman for the culpability she had in causing the zebra's death, and the investigation by Mr. Otto dragged on for many months.
Part of my responsibilities as a veterinary pathologist at the Zoo and as co-chairman of the IACUC is to look out for the welfare of the collection animals and to report animal welfare problems to the Director. Unfortunately, the zebra's death was just one of a number of examples of Spelman's poor judgement and practice of veterinary medicine; I knew of several other examples and I decided that, for the sake of the animals and the Zoo's reputation, the administration at the Zoo and/or the Smithsonian had to do something to ensure that a better quality of veterinary medicine was provided at the Zoo. Therefore, my plan was that soon after the new Zoo Director was selected in 2000, I would approach him/her to discuss the "Spelman problem".
In June 2000, Smithsonian Secretary Larry Small shocked the entire zoo community by announcing that he had picked Spelman to be the new Zoo Director --- a job for which Spelman had not even applied. In so doing, Small completely ignored the fact that a search committee had already completed a proper selection process under federal guidelines. He circumvented the federal hiring process by hiring Spelman under the Smithsonian's trust fund, which apparently does not have the same legal requirements that federal hiring does. Although this is probably legal, it certainly seems to me to be questionably ethical.
At the time Spelman was chosen to be Zoo Director, she had been in charge of the Department of Animal Health (a department that consisted of only about 10 people) for just 9 months; this was the sum total of her administrative experience. Under Spelman, the Department of Animal Health had quickly descended into chaos --- this proved to be a harbinger for what would happen to the entire Zoo under her "leadership".
After I got over the initial shock of Spelman's appointment as Director, I realized that my plan to go talk to the new Director about Spelman would have to be aborted; obviously there is a conflict of interest for me to report to Director Spelman (who is directly in my supervisory chain-of-command) the problems that I have discovered in the medical care and/or advice that veterinarian Spelman had provided. However, even though I had extreme reservations about her abilities to be a director, I had great hopes that Spelman would cease practicing veterinary medicine entirely and put all her attention on being the Director. Unfortunately, this did not happen.
But what did happen is that I began to more carefully scrutinize the veterinary care provided by Spelman and other clinical veterinarians at the Zoo; I have now documented numerous cases in which I believe there has been malfeasance, questionable animal care, and/or veterinary medical malpractice since 2000. I also went back and took a second look at a couple of "high profile" cases from 1998 and discovered more highly questionable things. Taken all together, I believe these cases establish a clear pattern of incompetence and unethical behavior.
During the course of the zebra death investigation by Richard Otto, I told him about 3 other "high profile" animals (an orangutan, an African elephant, and an African lion) for which I felt Spelman and the other veterinarians provided substandard veterinary care and/or malpractice of veterinary medicine in 2000. And I also told Otto of my concerns about the overall quality of veterinary medicine being practiced at the Zoo. After many months passed, Otto contacted me and said that, although he agreed I was probably correct about the cases, he was not a veterinarian and thus neither he nor anyone else in the Inspector General's office could pass judgement on veterinary medical issues. He then suggested that I take this before a body that does have oversight on such issues. However, Otto also reminded me that Spelman was "hand-picked" by Secretary Small to be the Zoo Director. He then warned me that if I did anything that made Spelman look bad, there undoubtedly would be consequences generated from the Smithsonian's administration that would adversely affect me and my career.
Despite Mr. Otto's warning, I next tried to find some kind of group with oversight over the practice of veterinary medicine in a zoo. I informally (and "off the record") went to representatives of the American Association of Zoo Veterinarians (AAZV) and the American College of Zoological Medicine (ACZM) and was told that neither of these two organizations has any powers or policies to review the quality of veterinary medicine practiced by its members. I then went to the American Veterinary Medical Association (AVMA) and found out that, although there are standards of veterinary care for domestic animal species, there are none for zoo animals. The AVMA basically just assumes the AAZV, ACZM, the Association of Zoos and Aquariums, and/or the individual zoos will establish and oversee such standards.
I then turned to the United States Department of Agriculture (USDA) and discovered that, except for some primates, marine mammals, non-rodent laboratory animals, and some "farm animals", the USDA does not have standards of care for zoo animals. But even if they did have such standards, both the Zoo and the USDA were working under the assumption that the National Zoo was not subject to compliance with USDA regulations (that was discovered to be an incorrect assumption earlier this year).
Therefore, I was unable to find any organization or government agency that had any power to review the quality of veterinary medicine practiced at the National Zoo. As a veterinarian and as co-chairman of the IACUC, I have an obligation to try to ensure that animals are treated humanely and are given proper veterinary care, and to report when this has not occurred. As a federal employee, it is my duty to report malfeasance by other employees at federal institutions. Although I am sorry that the Zoo has had so much bad publicity this year, this did force the Smithsonian and Congress to order the formation of a committee with oversight to review animal care at the Zoo. After more than 3 years of searching for a forum in which to present my findings, I am greatly relieved to finally have the opportunity to present this information to your committee.
For each case that I describe below, I present a brief summary of the case, along with the problems that I think are present; this is followed by questions relating to the case that I hope you will ask yourself and also ask each person involved with the case. It is my belief that you will find the answers to these questions to be quite disturbing. The pertinent documentation for each case is submitted as a separate packet to accompany this letter.
Case #1 Grevy's zebra (accession #113393; Pathology case #2000-0032)
Case-related documents are: 1) the medical records (pages 1A1- 1A5); 2) the pathology report (pages 1B1 and 1B2); 3) the IACUC report (pages 1C1 1C6)
A Grevy's zebra died at the Zoo overnight on January 31-February 1, 2000 due to a combination of starvation and exposure to cold. This was a young and growing animal. In the previous October (1999), Dr. Spelman observed both this zebra and the other two in the exhibit and decided they all looked "pot-bellied". She concluded that they must be overweight, so she ordered the daily rations of food for all the zebras to be cut in half. After she ordered the diet reduction, Spelman never returned to check on the condition of the zebras. Spelman was summoned to exam this zebra on the afternoon of January 31 because of concern by the curator and keeper staff that it looked thin and was "down in stall". Spelman just gave a visual exam of this animal, saw that it was standing and walking at that time, and decided it was "eating weakly" and had "small muscle mass of chest and hindquarters". Although Spelman states that her plan is to "exam ASAP", she decides that "given the time of day", she will plan the examination for "first thing tomorrow". Later that day (at 2 pm), the zebra was reported to be "down in stall" and Spelman decided that the zebra had to be examined right away. At this examination, Spelman and Dr. Becky Yates discovered the zebra to be very hypothermic (93.1 F) and severely underweight.
The animal was given several drugs to treat it for shock and pain. But instead of moving the animal to warm quarters, Spelman and Yates left it to die in a cold stall while they went home for the evening. The zebra was found dead in the stall the next morning.
This is the case that prompted the IACUC investigation by Lisa Stevens and me, as well as the investigation by Richard Otto from the Office of the Inspector General.
Question line 1: Any competent animal caretaker knows that a young animal with a "pot-bellied" appearance is not necessarily fat (just think of the pictures of malnourished children in third-world countries). Wouldn't a competent veterinarian realize that a pot-bellied animal is often not a fat animal?
Question line 2: It is common sense to avoid drastically reducing an animal's diet when cold weather is approaching in fact, one usually increases the rations. Why did Spelman order the rations cut in half? Isn't this a drastic reduction of the diet for a young, growing animal especially as cold weather is approaching? Is this reduction something a competent veterinarian would order?
Question line 3: After ordering the dietary rations drastically reduced, why did Spelman not go back and check on the zebras for more than 3 months?
Question line 4: The fact that Spelman ordered this diet reduction was told to Lisa Stevens and me by the curator (Stuart Wells) and three animal keepers (Juan Rodriquez, Dennis Davis, and Craig Saffoe). After being told this, I then asked Spelman directly about this and she acknowledged that she did order the diet reduction, but then said that since this was in the Fall, it had nothing to do with the animal's condition in January. Is that logical? Does a competent veterinarian make such conclusions? Why did Spelman not make any entry in the zebras' medical records about her order to reduce the rations?
Question line 5: Why do the medical records indicate that this zebra was looked at and later treated on February 1, when in fact this occurred on January 31? Why do the records indicate that the zebra was found dead on February 2, when in fact it was found dead and necropsied on February 1? ' Don't the inconsistencies in dates indicate a lack of competence in keeping accurate medical records? How would it be viewed in a court of law if a veterinarian or medical doctor in private practice kept such inaccurate records?
Question line 6: The medical records indicate that Spelman initially looked at the zebra sometime before 2 pm on "February 1" (actually January 31) and decided that the animal needed to be examined "ASAP". Yet she then decided that this exam should be done the next morning "given the time of day and cold ambient temps". What is Spelman's definition of "ASAP"? Doesn't this seem to actually mean "as soon as convenient" for Spelman? The first medical records entry on this day was obviously made before 2 pm because a subsequent entry states that at 2 pm the zebra was down and Spelman decided to exam it that day after all; does this mean that Spelman only performs "ASAP" exams before 2 pm? What are the ethics and competence of a veterinarian who, after deciding in the early afternoon that an animal needs a physical examinaton "ASAP", decides to put off this exam until the next day? If a veterinarian in private practice made such a decision and the animal then later died the same day, wouldn't that be legitimate grounds for an owner to sue for malpractice? Isn't it possible that this zebra might have been saved if it had been given (proper) medical attention sooner?
Question line 7: Why did Spelman and Yates leave a hypothermic animal in a cold stall overnight? Wouldn't a competent veterinarian have either moved the animal to warmer quarters or stayed to ensure that adequate heat was provided? Isn't this a case of malpractice of veterinary medicine -- or is it merely incompetence?
Case #2 Orangutan (accession #100797; Pathology case #2000--0294)
Case-related documents are: 1) the medical records (pages 2A1 2A21); 2) the pathology report (pages 2B1 and 2B2); 3) the euthanasia request form (page 2C1); 4) the log of samples from this orangutan submitted during 2000 to the clinical pathology laboratory (page 2D1); 5) results of fecal sample cytology and parasitologic exams for July 2000 (pages 2E12E10)
On July 28, 2000, Spelman euthanized an adult female orangutan. This animal had had a malignant intestinal tumor removed in January, 2000. Following removal of the intestinal neoplasm, the orangutan did very well for many weeks. The medical records clearly indicate that during the period from February through April, the animal had one day (February 6) on which its stools were loose, but otherwise the orang was fine. In May, there were two bouts of diarrhea but these responded to anti-protozoal therapy.
Between July 3 and July 24, several fecal samples from this animal were submitted (by order of Spelman and/or other clinical veterinarians) to the Department of Pathology for examination due to diarrhea. Samples were submitted for parasitological exam on July 3, July 6, July 10, and July 18. Samples were submitted for cytological exam on July 3, July 10, July 18, July 21, and July 24. No samples were submitted for bacterial culture even though the cytology results consistently indicated alterations in normal intestinal microflora with gram negative bacterial overgrowth.
The first entry in this animal's medical records for July was not made until July 25, and this states that the orang was depressed and had abdominal distention. The next entry was made on July 26 and indicates that the orang's condition was about the same. The next and final entry was made by Spelman on July 28 and it discusses the decision to euthanize the orang that day without performing any additional diagnostic tests. Spelman indicates that the most likely reason for the animal's clinical signs is recurrence or metastasis of the intestinal neoplasm. She also states "that the only way to determine recurrence of neoplasia or other new problem was to do exploratory surgery, that ultrasound as a noninvasive technique would not be diagnostic of a bowel stricture secondary to prior surgery or of diffuse liver metastatic lesions". Furthermore, Spelman states that the orang's "stools had simply never become normal after surgery".
However, just before euthanizing the orang, Spelman did in fact perform an ultrasound exam on the animal; this was done at the request/insistence of Assistant Curator Lisa Stevens and was witnessed by several people including Stevens and animal keeper Melanie Bond. Spelman told those in attendance that the ultrasound showed that there were multiple metastatic tumors in the orang's liver, and this was the final justification she used to euthanize the orang.
However, the necropsy revealed that in fact there were no grossly visible tumors in the liver. Metastatic tumors were eventually found in the pancreatic lymph node and in three small (< 2 cm diameter) foci in the mesentery but the liver was free of neoplasia.
Cultures of the intestine taken at necropsy grew a species of Salmonella and histologic lesions were compatible with a bacterial enterocolitis. Thus, the orangutan had diarrhea because of salmonellosis -- which is a treatable disease.
This means that an adult orangutan was unnecessarily killed by Spelman because she improperly diagnosed why it had diarrhea.
Question line 1: Why didn't Spelman request bacterial cultures of feces when the orang had a prolonged bout of diarrhea? This is a standard diagnostic test that competent veterinarians (and medical doctors) use when trying to determine a cause of diarrhea. Isn't the failure of Spelman to order a bacterial culture on this orangutan malpractice of' veterinary medicine especially in view of the fact that multiple parasitology exams were performed in July and were negative for parasites, and the multiple cytology exams of the feces (which she ordered and apparently ignored) indicated there was gram negative bacterial overgrowth?
Question line 2: Why did the curator have to request an ultrasound examination before euthanasia? Isn't this a standard diagnositc test performed by competent veterinarians? Wouldn't a competent veterinarian have decided to perform an ultrasound exam in an attempt to confirm the diagnosis of neoplasia before euthanizing this orangutan?
Question line 3: On the day the orang was euthanized, a team of ultrasound experts from Germany was visiting the National Zoo to ultrasound a pregnant Asian elephant as part of the routine pregnancy monitoring. This team had willingly performed ultrasound examinations of other animals at the National Zoo in the past. Curator Lisa Stevens asked Spelman to ask the Germans to ultrasound the orang. Why did Spelman refuse to do so and instead decide to perform an ultrasound exam herself? Is Spelman as competent with ultrasound as this German team? Does she think she is as competent?
Question line 4: Why did Spelman diagnose metastatic neoplasms in the liver based on her ultrasound exam? Isn't this obviously malpractice of veterinary medicine?
Question line 5: Why didn't Spelman state in the medical record that she had performed an ultrasound exam on the orang and/or that she had diagnosed metastatic neoplasms in the liver based on her ultrasound exam? Isn't this an obvious attempt to cover-up her malpractice?
Question line 6: In fact, the wording of Spelman's medical entry on July 28 suggests that an ultrasound examination was considered but was not done because it would not be diagnostic "of diffuse liver metastatic lesions". Isn't this another obvious attempt by Spelman to cover-up her malpractice?
Question line 7: The orangutan was property of the federal government and thus the medical records on this animal are federal documents. Why did Spelman intentionally falsify an official document of the federal government? Isn't falsification of government documents considered to be a felonious crime ?
Question line 8: There are several entries in the orang's medical records that state the animal had normal stools in the period between the surgery and July. Yet Spelman states in the medical entry she made on July 28 that the orang's "stools had simply never become normal after surgery". Is this another example of intentionally falsifying the medical record in Spelman's further attempts to justify euthanasia of the animal and to cover-up her malpractice?
Question line 9: On the "Request for Specimen Euthanasia" form that appears to have been filled out in Spelman's hand-writing, it is stated that "The orang suffered from chronic diarrhea nonresponsive to medicine for several months ever since surgery for the neoplasia." In fact, the medical records clearly show that this statement is untrue; the animal did not have diarrhea for most of the period following surgery and the bouts of diarrhea it had prior to July did respond to medicine. Isn't this yet another example of falsification of a federal document to cover-up Spelman's malpractice?
Question line 10: The "Request for Specimen Euthanasia" form was supposedly signed by Spelman on the day the animal was euthanized (July 28,2000). Why did Spelman check the box saying she "disapproved" the euthanasia? Is this an indication of a lack of competent record keeping? Why didn't Dr. Becky Yates (as representative of the Department of Animal Health) sign this form until March 1, 2001 --- more than 7 months after the euthanasia? This form was also supposed to be signed by the animal curator in charge of the orang; why did the curator, Lisa Stevens, never sign the form?
Case #3 African elephant (accession #26223; Pathology case #2000-0331)
Case-related documents are: 1) the medical records (pages 3A1 3A102); 2) the pathology report (pages 3B1--3B4); 3) the euthanasia request form (page 3C1);
4) Spelman's e-mail message from August 23, 2000 (pages 3D1 and 3D2);
5) Spelman's e-mail message from September 18, 2000 (page 3E1)
Spelman euthanized an adult female African elephant on August 22, 2000. She had been treating this animal for many months for bloating and lameness. As part of this therapy, Spelman placed the elephant on long-term continuous treatment with prednisone (beginning on January 24, 1999 and continuing until the elephant was euthanized on August 22, 2000). The severe foot problems (osteomyelitis), lameness, and weight loss are the reasons Spelman and Yates used to justify finally euthanizing the elephant (after it had become so lame that it could barely stand).
The post mortem examination revealed that the elephant's lungs were riddled with lesions that were highly suggestive of tuberculosis. Therefore, we pathologists immediately made cytologic imprints of some of the lung lesions; within an hour, acid-fast stains on these slides had confirmed the presence of bacteria consistent with a species of Mycobacterium the organisms that cause tuberculosis. This was reported to Spelman the day of the necropsy.
The next day (August 23, 2000), Spelman sent out an e-mail message to several Zoo staff members in which she instructs the Office of Public Affairs to investigate how other zoos handled the "public relations" of having a tuberculous elephant. But in this e-mail Spelman states that "This does NOT include calling the different institutions and talking about this issue since we do not have a firm diagnosis." Later in this e-mail message Spelman states that if tuberculosis is confirmed through culture methods (thus necessitating changes in management of the remaining elephants): "I do not forsee that we would call a press release to "announce" this situation unless our decisions affect public viewing of the elephants and other animals in the elephant house. But I intend to be open and informative about it when the topic arises."
Spelman was informed as soon as head pathologist Dr. Dick Montali was told that culture results indicated that the species of Mycobacterium present in the elephant was M. bovis rather than M. tuberculosis (which is more contagious to humans). Two days later (September 18, 2000), Spelman sent out another e-mail message. In this message, she discussed how she wanted to deal with a film crew from the BBC that was scheduled to arrive soon to film the ultrasound procedures done on the pregnant elephant. Spelman states: "With respect to the BBC film crew, please keep things simple and explain that our restrictions surrounding visitors and close contact with our elephants are safety precautions that were increased somewhat when the group dynamics changed with the loss of the African elephant." Later in this same message she states: "At this time, I do not see the need to discuss the m. bovis issue with the BBC crew unless asked directly... If they or others ask what was wrong with Nancy, the answer should be "multiple problems, including osteomyelitis and severe arthritis, fairly sudden severe weight loss. but we are still waiting for final necropsy results". If asked a pointed question (elephants are commonly found to have TB at necropsy, did she have it..?) then of course be truthful..."
Since 1997, the USDA regulations have required that all elephants in this country be tested at least once a year for tuberculosis. Spelman did perform these tests on the Zoo's elephants in 1997 and 1998. However, Spelman did not test this animal (or any of the other elephants at the Zoo) for nearly 2 years (October 1998 August 2000) prior to the death of the African elephant, which is a clear violation of federal regulations.
Question line 1: Why was this animal not given the annual tests for tuberculosis as required by the USDA? If any other zoo in the U.S. had violated these USDA regulations by failing to perform timely TB testing, wouldn't that zoo have been subject to sanctions by the USDA? How would the USDA view things at any other zoo if an elephant that was nearly a year overdue for its annual TB testing was subsequently found to have a severe case of TB?
Question line 2: If this elephant had been tested for TB in a timely manner (i.e. when testing was due in October 1999 or sometime shortly afterwards), isn't there a good chance the test would have revealed that she had TB? If tuberculosis had been diagnosed in this elephant ante mortem, couldn't the animal then have been either treated for the disease or euthanized much sooner? Therefore, didn't Spelman's failure to test this elephant for TB result in needless and prolonged suffering for this animal? Also, didn't keeping this elephant alive and untreated pose a health risk for humans (staff and visitors) and the other animals in the Elephant House exposed to this infected elephant?
Question line 3: Why did Spelman treat this elephant for so long (more than 18 months from January 24, 1999 until August 2000) with prednisone a drug that suppresses the immune system? Since elephants are known to be very susceptible to tuberculosis, wouldn't an elephant with a suppressed immune system be much more likely to become infected? Would a competent veterinarian treat an elephant with immunosuppressive drugs for such a prolonged period?
Question line 4: Would a competent veterinarian use immunosuppressive drugs as part of the therapy in any animal with bacterial osteomyelitis? The medical records entry that Spelman made on 23May1999 (after the elephant had already been on prednisone continuously for 4 months) states that the elephant was "at risk for secondary bacterial infections on pred therapy". Then why did Spelman leave the elephant on prednisone therapy even after the diagnosis of osteomyelitis had been established through radiography (as recorded in the entry made on 7July1999)?
Question line 5: The elephant's lameness had become bad enough that Spelman made the following entry in the medical records for 15August1999 "Discuss plans/parameters for euthanasia". The entry on 18August1999 states "Discussed prognosis, euthanasia with keeper and curatorial staff all agreed that pain and change in attitude will be deciding factors". On 20August1999, the elephant was noted to be "severely lame". By 6September 1999, the elephant was lame on the right front (RF) foot as well as the left front (LF) foot, and it is stated that "euthanasia likely soon if RF lameness worsens"; this statement is repeated on 10September1999. Over the next 10 months, there are numerous entries in the medical records stating that the lameness in both front feet was worsening and that the osteomyelitis in the left front foot was progressing or at best static (i.e. no improvement). By 24July2000, the elephant was developing pressure sores on the skin over left side of its head and left shoulder; these sores were the result of the animal leaning against the walls of its enclosure to take the weight off of its feet as it tried to sleep at night. The records entry on 31July2000 note that the elephant "layed down the other day for a few hours" --- which is not normal elephant behavior. By 19August2000, the elephant was "resting her head on the bars of the stall" in order to take the weight off of her feet. On August 22, 2000, the elephant was finally euthanized --- more than a year after the medical records first state that the animal's condition was bad enough that euthanasia should be considered. Why was this elephant forced to live so long with lameness in both front feet? What was the quality of this animal's life during this time? The elephant had become so painful in its feet by 24July 2000 that it developed pressure sores from leaning against the walls to take weight off its feet, yet it was forced to live for almost another month --- why? What is the competence and ethics of a veterinarian who allows an animal to suffer for so long?
Question line 6: This elephant was euthanized and necropsied on August 22, 2000. Why don't the medical records in the days to weeks prior to August 22, 2000 discuss the plans for euthanasia? Why is there no entry in the medical records for 22August2000? How was the elephant euthanized? What drugs were used? Were any of the drugs used considered to be "controlled substances" by the Drug Enforcement Agency (DEA), and if so, doesn't the DEA require careful record keeping for such drugs? Wouldn't it be useful to be able to refer to the medical records and the euthanasia procedure for this elephant if and when another elephant needs to be euthanized in the future? Would a competent veterinarian fail to make a medical records entry for this elephant on the day it was euthanized?
Question line 7: Doesn't Spelman's e-mail message on August 23, 2000 give the impression that she wishes to prevent other zoos and the media from finding out that the Zoo's elephant had tuberculosis? Why does Spelman want to suppress revelation of that information? Doesn't this sound like a cover-up? Is this being "open and informative"?
Question line 8: In regards to Spelman's e-mail message on September 18, 2000 (which was written in response to her learning that the culture results indicated that the elephant did indeed have a form of tuberculosis), why did she instruct Zoo staff to explain to the BBC crew that "our restrictions surrounding visitors and close contact with our elephants are safety precautions that were increased somewhat when the group dynamics changed with the loss of the African elephant"? Isn't this clearly a lie or at best a "half-truth"? Weren't the restrictions instituted primarily because the African elephant was found to have TB at necropsy? What are the ethics of someone who instructs her staff to respond in such a manner? Should a person with these ethics be the director of "the National Zoo" of the United States of America?
Question line 9: Also in her e-mail message on September 18, 2000, Spelman instructs staff that: "If they or others ask what was wrong with Nancy, the answer should be "multiple problems, including osteomyelitis and severe arthritis, fairly sudden severe weight loss. but we are still waiting for final necropsy results"."' Isn't this a highly evasive and less than totally truthful answer since Spelman had already been informed that the necropsy results indicated the elephant had TB and that the lung culture results indicated the organisms present were Mycobacterium bovis? What are the ethics of someone who instructs her staff to respond in such a manner? Should a person with these ethics be the director of "the National Zoo" of the United States of America?
Question line 10: Again in her message of September 18, 2000, Spelman instructs staff that: "If asked a pointed question (elephants are commonly found to have TB at necropsy, did she have it..?) then of course be truthful..." Why does Spelman require that staff members only be truthful if asked a pointed question? What are the ethics of someone who instructs her staff to respond in such a manner? Should a person with these ethics be the director of "the National Zoo" of the United States of America?
Question line 11: I have heard Spelman present the excuse that the reason the elephants were not given the USDA-required annual TB tests when they were due (October 1999) was because the Department of Animal Health (DAH) was short-staffed and the veterinarians were just too busy tending to the sick aged male giant panda and the African elephant's foot problems. Isn't this an admission by Spelman that she and the other vets were ignoring the rest of the zoo animal collection (and USDA regulations) because they were devoting all their attention to just 2 animals? How much time did the vets actually spend each day on these 2 animals? Is this something that competent veterinarians would do?
Question line 12: When fully staffed, DAH has a head veterinarian, an associate veterinarian, and a clinical resident (who is also a veterinarian). Spelman was named head veterinarian in September 1999 and Becky Yates joined the staff as associate veterinarian in November 1999; Dr. Jody Sherrill was the clinical resident from August1998- July 2000. Although DAH was short one associate veterinarian at the time the elephant TB testing was first due in October 1999, it was fully staffed from November 1999 through August 2000; why weren't the elephants tested during this time?
Question line 13: The chronically-ill giant panda was euthanized on November 28,1999. Even if trying to treat this panda was a legitimate excuse for ignoring the rest of the zoo animal collection (and USDA regulations), what is the excuse for not performing the TB tests on the elephants from December 1999 through August 2000?
Question line 14: Treating the African elephant's foot problems and its other chronic health issues required one or more members of the DAH vet staff to go down to the Elephant House on almost a daily basis. Why weren't the elephants TB tested during these frequent visits? How long does it take to TB test each elephant? Isn't true that the TB testing procedure (i.e. a trunk wash) merely requires that a vet be present to observe the procedure and that the elephant keepers actually administer the tests? Therefore how much of the veterinarians' time do these procedures actually take?
Question line 15: There are 8 hours in a workday and there were 2 or 3 vets in DAH during the entire period from October 1999 through August 2000. Isn't Spelman's inability to juggle her schedule (or that of the other vets in her department) to conduct some routine (and quick) TB tests an indication of incompetent management of DAH (a department consisting of only10 people)? Is a person who could not effectively manage DAH qualified and/or competent to be director of the entire Zoo?
Case #4 African lion (accession #107851; Pathology case #2000-0453)
Case-related documents are: 1) the medical records for November-December 1995 (pages 4A1 and 4A2); 2) the medical records for the year 2000 (pages 4B1-- 4B15);
3) the pathology report (pages 4C1 4C3); 4) the euthanasia request form (page 4D1)
A female African lion was euthanized on December 4, 2000 after many months of illness. The medical records indicate that the animal was anesthetized and given a physical exam (including dentistry) on January 21, 2000. On February 29, Spelman placed the lion on prednisone therapy but the reason for this was not given. The medical entry on March 2 indicates that the prednisone therapy is to treat the animal's locomotion problems, which Spelman attributes to spondylosis. In April, there are several entries indicating that the lioness was having bouts of anorexia. On May 8, Spelman also placed the animal on glucosamine chondroitin to treat the animal's "stiffness". Entries made on May 18 and June 14 indicate that this animal had problems with mastication. The lion was anesthetized on June 16 and again on August 24 for dental examinations and a molar tooth was extracted on August 24. The medical entry on August 26 notes that the animal "was still doing the same eating/tongue behavior as pre-surgery". The entry on August 27 notes that abnormal tongue movement persists. On September 20, the lion "still has some difficulty eating" and her "tongue is hanging out about ½ way with less muscle tone". On September 23, the medical entry states "keepers report increasing difficulty eating" and Spelman orders the dose of prednisone increased. On September 24, the lion is noted to have "large amount of difficulty getting food down" and that "she tires of it easily and won't finish a meal". On October 2, the lion is again anesthetized and transported up to Gaithersburg, Maryland where an MRI exam is performed on her head. As a result of this exam the medical entry states that they "can likely rule out brain tumor" and thus the "most likely remaining condition is steroid responsive inflammatory". On October 11, the lion is placed on antibiotic therapy to treat a possible urinary tract infection (UTI) because Spelman observed the animal to have "continued squatting and straining as animals with UTI's will do". On October 27, the medical entry states that "keepers are still noting her straining a lot" and that she has minimal (min) "tongue motion". On November 2, Spelman decides to reduce the prednisone dose because "straining to urinate may be related to polyuria from the pred". On November 7, the lion is given an injection of dexamethazone (dex SP). There is "concern that a secondary problem may be developing" and one such problem listed is "neoplasia". This animal's abdomen is noted to be "possibly distended" and there is "concern about fluid in the abdomen or poss mass". On November 8, Spelman gives this animal additional injections of dexamethazone. A urinalysis (UA) is performed and shows no indication of a urinary tract infection. On November 13, another urinalysis is performed and it again shows no indication of a urinary tract infection. On November 20, the lion is placed on a 7-day treatment of antibiotics but the reason for this is not stated. On November 28, topical sprays of silver sulfadine cream are prescribed but the reason for this is not stated. By December 3, the lion's quality of life had become so miserable that the "consensus is to euthanize animal" the next day. On December 4, the lion was euthanized and the medical records indicate that the abdomen was "distended and turgid". Post mortem radiographs of the abdomen and thorax were taken.
At necropsy, the lion's abdomen was filled with multiple masses ranging from 0.5 cm to greater than 10 cm in diameter. These masses involved most of the abdominal organs, including the urinary bladder, and extended deep into the pelvic canal. Histology revealed these masses to be "spindle-cell sarcomas" of undetermined origin. This animal's long history of abnormal tongue movements was attributed to a localized peripheral neuropathy associated with a "paraneoplastic syndrome". Another abnormal finding at necropsy was that the cervix and 15 cm of one uterine horn were present but the other uterine horn and the ovaries could not be located.
Question line 1: This animal was anesthetized 4 times in 2000 (January 21, June 16, August 24, and October 2) for physical exams and/or clinical work-up for its "tongue problem". However, there is no indication in the medical records that the abdomen was ever palpated or radiographed until after the animal was dead. Shouldn't this be part of a routine physical exam --- especially in an animal such as a lion? Had this animal's abdomen been examined on October 2, the masses in the abdomen would surely have been detected; histology revealed these were NOT rapidly-growing neoplasms and thus must have been present for weeks to months. In fact, the masses most probably could have been detected during the August and June exams (and perhaps even in January). But the exams given in January, June, August, and October just concentrated on the lion's head and mouth. Wouldn't a competent zoo veterinarian have performed a complete physical examination of this lion each time the animal was under anesthesia? Isn't the failure to perform complete physical examinations of this lion on multiple occasions malpractice of zoological veterinary medicine?
Question line 2: If the masses had been detected in the abdomen on October 2 (or sooner), the lion would surely have been euthanized well before December. Therefore, didn't the failure of Spelman and the other clinical vets to perform examinations of the lion's abdomen result in weeks to months of needless suffering by this animal?
Question line 3: The reason the lion was straining to urinate for approximately 2 months prior to its death was because of impingement of the urinary bladder and the urethra by multiple tumors. Yet Spelman first decided that the stranguria was likely due to a urinary tract infection and placed the lion on antibiotic therapy without ordering a urinalysis or otherwise confirming that an infection was present (in fact the first urinalysis was not performed until 4 weeks later). Is this something a competent veterinarian would do? If this lion did indeed have a urinary tract infection, wouldn't it most likely have been associated with the prolonged treatments with prednisone?
Question line 4: The medical record entry on November 7 mentions twice that the lion might have neoplasia. Yet there was no follow up on this. Why was this lion forced to live another 27 days without a follow up examination? What was the lion's quality of life during this time?
Question line 5: Why don't the medical records state the reason this animal was placed on antibiotic therapy on November 20, 2000? Why don't the medical records state the reason this animal was placed on topical therapy with silver sulfadine crθme on November 28, 2000? How long did this lion suffer with urine scalding and/or decubital skin ulcers (which were noted at necropsy and in the information provided by Yates just prior to the necropsy)?
Question line 6: The medical records indicate that the decision to finally euthanize this lion was made on December 3, 2000 -- after discussion with the keepers and curator. Yet the "Request for Specimen Euthanasia" form for this animal was not filled out by Becky Yates until February 6, 2001 (more than 2 months after the animal was euthanized). Why was there such a delay? Isn't it Zoo policy in a case like this (i.e. elective euthanasia of a chronically ill animal) to initiate this euthanasia form before the euthanasia is done?
Question line 7: On the "Request for Specimen Euthanasia" form, Yates indicates that the lion had "chronic progressive dysphagia" and that there was "no diagnosis despite extensive medical work up". Shouldn't an "extensive" ante mortem work up of this lion have included examination and radiographs of the abdomen?
Question line 8: The medical records of this lion state that on 29November1995, Spelman performed an ovariohysterectomy. Yet at necropsy, the cervix and 15 cm of one uterine horn were present (because of displacement and distortion by the numerous sarcomas, which one of the uterine horns that was present was not determined). Doesn't the successful performance of an ovariohysterectomy in domestic cats (and dogs) by a competent veterinarian require removal of the cervix and both uterine horns? Isn't Spelman's failure to remove the cervix and one uterine horn in this lion a case of malpractice of veterinary medicine?
Case #5 Bongo antelope' (accession #110565; Pathology case #2001-0202)
Case-related documents are: 1) the medical records (pages 5A1-5A10); 2) the pathology report (pages 5B1 and 5B2); 3) the euthanasia request form (page 5C1)
The medical records on this bongo state that it was anesthetized and given a physical exam on December 19, 2000. The medical record entry on this date indicates that another bongo (presumedly housed with this one) died 8 months previously with Mycobacterium avium infection; therefore this animal was given a "bovine TB test" on Dec. 19. The medical record entries from December 20-25 indicate that the TB test site in the skin is swollen --- suggesting possible infection with a Mycobacterium species. The stated plan on December 25 is to "consider immobilization for complete PEx" (physical exam). There are no additional entries in the medical records until January 26, 2001 when it is noted that the bongo had "soft stool". On Janurary 29, the animal is noted to have "watery diarrhea and depression" and it is started on an antiflammatory drug (banamine) and an antibiotic (ceftiofur). On February 8, the animal is noted to have "chronic weight loss, diarrhea, and inappetance" and the plan was to "consider repeat work-up". On February 12, 2001, the records indicate that Spelman ordered 7 days of treatment with a different antibiotic. After February 16, there are no more entries until May. On May 26, the entry states that there are "loose, but not watery stools" and the assessment was the bongo had "weight loss with thin appearance". On May 28, the bongo is noted to have "watery stool" and fecal samples were requested for "fecal, culture, cytology". On May 29, the curator is reported to have said the bongo has "explosive watery diarrhea" and a decision is made to culture the feces. It is also stated that the plan is to "consider immobilization for exam". Between June 2 and June 9 there are several medical entries referring to the animal's chronic diarrhea. On June 15, 2001, the bongo is finally anesthetized for a "complete" physical exam. It is stated that the bongo was ataxic before the exam that day. During this exam, radiographs of the thorax were taken; there is no indication that abdominal radiographs were done or that either abdominal or rectal palpations were performed. On June 19, 2001, the bongo was euthanized. The information on this case submitted along with the carcass by the Department of Animal Health stated the following: "This bongo had a long history of weight loss associated with intermittent diarrhea that initially appeared responsive to antibiotics. Although the diarrhea resolved, the bongo became ataxic and was drooling. Euthanasia elected due to poor prognosis."
The necropsy revealed that this bongo had a large benign uterine neoplasm that almost completely filled the pelvic canal --- markedly compressing the distal colon and rectum.
Question line 1: The medical records indicate that this bongo had clinical signs of "soft stools" to intermittent diarrhea from January 26 through June 9, 2001. However, this bongo was not anesthetized and given a physical exam until June 15, 2001. Why did nearly 5 months pass between the initiation of signs of abnormal stools and a physical examination for this problem? Is this delay something that a competent veterinarian in private practice would do?
Question line 2: Why didn't the physical exam performed on June 15 include abdominal or rectal palpation and/or radiographs? Wouldn't a competent veterinarian include these exams in a routine work-up of a ruminant this size? If rectal or abdominal palpation and/or abdominal radiographs had been done, would they have revealed the presence of the pelvic neoplasm? The uterine tumor in this animal was a benign and slow-growing one; isn't it likely that if a complete physical exam had been performed on this animal weeks to months before June 15, this tumor would have been detected? Therefore, didn't the failure to perform a complete physical exam on this animal sooner possibly result in prolonged suffering by this bongo?
Question line 3: Could the ataxia noted on June 15 have been caused by a large pelvic tumor impinging on nerves in this region? Could the intermittent diarrhea have been caused by this tumor? Could the weight loss have been caused by this tumor? Therefore, could all of this animal's chronic clinical signs have been associated with this tumor? There is no indication in the medical records that the veterinary staff ever considered the possibility that bongo might have neoplasia; was this ever a consideration?
Question line 4: The last medical records entry is on June 16 (the day after the physical exam) and stated only that flunixin meglumine (aka banamine) was prescribed until further notice. This bongo was euthanized 3 days later. Why is there no entry in the medical records about the decision to euthanize this bongo and/or that the animal was euthanized?
Question line 5: What criteria were used to decide to euthanize this animal? Who made the decision? What is the Zoo's policy/protocol for elective euthanasia of a chronically ill? Was this policy followed for this bongo? Why doesn't the "Request for Specimen Euthanasia" form (which was apparently signed by Murray and the curator on the day of euthanasia) list a reason for the euthanasia?
Question line 6: In the information provided by the Department of Animal Health at the time of necropsy, it is stated that this animal's diarrhea had resolved. There is nothing in the medical records to indicate that the diarrhea had resolved; the entries made on June 8 and June 9 indicate that the feces are still abnormal. Did the diarrhea ever actually resolve and if so, when and why wasn't this noted in the medical records?
Question line 7: This animal was given a TB test in December and the medical records clearly indicate that there was a reaction (i.e. "TB site is swollen") for several days. But there is no indication about whether this animal was actually considered to be a positive reactor or merely a suspicious one. Neither is there any indication that follow-up TB testing was performed. What are the federal guidelines on TB testing of hoofstock, especially about how to deal with positive or suspicious reactors? Were these guidelines followed in this case?
Case # 6 Two-toed sloth' (accession #105802; Pathology case #2001-0224)
Case-related documents are: 1) the medical records (pages 6A1 6A4); 2) the pathology report (pages 6B1 and 6B2); 3) the log of blood samples from this sloth submitted during 1995-2001 to the clinical pathology laboratory (page 6C1); 4) results of the analysis of the blood samples submitted from this sloth (pages 6D1 6D8)
This sloth was found dead in its exhibit on July 17, 2001. In the information provided by the curatorial/keeper staff to the Department of Pathology, it was stated that on the day before it was found dead, the sloth was noted to be displaying abnormal behavior. The necropsy of this animal revealed that it had multiple problems including severe kidney disease with secondary lesions indicative of chronic renal failure.
The medical records on this animal state that it was given "annual" physical examinations on 8August1995, 26August1996, 5August1998, and 23September1999. There are no entries in the medical records after 23September1999. Analysis of the blood sample collected at the September 1999 exam revealed significant increases in the blood urea nitrogen (BUN) and serum creatinine, as well as anemia; these findings are indicative of compromised renal function.
Question line 1: This sloth had 4 "annual" physical examinations in the approximately 4-year period from August 1995 through September 1999. But it did not have another exam from September 1999 until its death in July 2001 (nearly 22 months). Why wasn't it given an annual physical exam during this period? Wouldn't competent veterinarians have continued the established program of annual physical examinations of this animal?
Question line 2: Since the blood sample collected at its last physical exam indicated compromised renal function, shouldn't this animal have been monitored closely and given timely follow-up exams? Isn't the failure to closely monitor this animal an indication of incompetence?
Case # 7 Giraffe (accession #106649; Pathology case #2002-0051)
Case-related documents are: 1) the medical records (pages 7A1 7A19); 2) the pathology report (pages 7B1 7B6); 3) a chapter on giraffe anesthesia (7C1- 7C4); 4) a chapter on the medicine and physiology of giraffidae (pages 7D1 7D11); 5) e-mail message from Montali to Spelman at 2:25 PM on February 11, 2002 in response to a message from Spelman at 1:41 PM (page 7E1); 6) e-mail message from Bob Hoage to Spelman in response to Spelman's message at 3:24 PM on February 11, 2002 (page 7F1)
This aged male giraffe had a long clinical history of intermittent lameness that appeared to somewhat respond to treatments with ibuprofen and other anti-inflammatory drugs, and "chondroprotectants". On July 18, 2001, this animal was anesthetized for treatment of chronic hoof problems. Beginning in August 2001, this giraffe was noted to intermittently display abnormal behavior where he would extend his neck and lower his head; this was interpreted to be signs of discomfort in the esophagus and/or forestomachs. On January 14, 2002, the medical records entry states that: "green liquid material found splattered on stall on Sunday and today Monday". Cytology of this material revealed that it was consistent with rumen contents. The medical records state that this animal may have "abnormal regurgitation" or "upper GI disfunction", and the plan was to "consider stop pain medication".
The medical records entry for January 15 states "More green fluid found this morning on floor." It is also noted that "keeper believes his abdomen is slightly enlarged". The assessment is that this giraffe has "abnormal rumination" and the plan is to "stop MSM and Ibuprofen today".
The next day the giraffe is noted to be "doing slightly better" and "there was no evidence of abnormal eructation today nor was there any evidence of the green fluid on the floor".
A medical record entry on February 4 indicates that Spelman prescribed that this giraffe be placed back on oral ibuprofen until further notice (UFN).
On February 5, it is noted that "no more greenish fluid observed in the past 11 days" and that "This animal has also been eating slowly than normal". However, the animal is also noted to be very lame on the right front leg. Therefore the plan is to "re-start ibuprofen on previous dose and monitor for regurgitation or signs of GI upset".
On February 6, the ibuprofen therapy was started again.
On February 7, the medical records state that: "Keeper requests foot x-ray to help diagnose problem of right front foot lameness". Therefore, this foot was radiographed and the findings are that the foot appears unchanged from when the foot was radiographed at the time of the hoof trim (on July 18, 2001).
On February 9, 2002, the giraffe was found down in the morning and appeared to be reluctant or unable to stand. The animal was treated with a variety of drugs but still was not attempting to stand 2 hours later. The giraffe was then rolled so that instead of lying with most of his weight on his left side, his weight was shifted to his right side. Within minutes, "he began to appear somewhat anxious and his abdomen began to look inflated". The animal's condition rapidly worsened and it died as the veterinary staff was preparing to euthanize it.
The necropsy revealed that the giraffe had severe bloating of the rumen and other forestomachs with frothy liquid contents. This animal died due to "frothy bloat" which is a well-known condition in domestic ruminants associated with abnormal microbial flora and/or abnormal food content in the forestomachs. This giraffe also had severe dental and gingival disease, which caused abnormal mastication thus contributing to abnormal rumination. Bacterial cultures of the rumen contents grew only Staphylococcus aureus and Streptococcus which is not normal. The final conclusion was that the development of fatal frothy bloat in this giraffe was caused by a combination of multiple factors, including severe dental disease, sinus infection, prolonged oral medications, and selective dietary choices by the giraffe (e.g. eating grain rather than hay).
Question line 1: Giraffes are notoriously difficult to safely anesthetize. When this giraffe was anesthetized on July 18, 2001, Dr. Nadine Lamberski, a veterinarian from another zoo in South Carolina, was brought in to assist with the procedure. This was done because Dr. Lamberski had more experience with giraffe anesthesia than Spelman or Murray. However, Dr. Mitch Bush who is located at the Zoo's Conservation and Research Center in Front Royal, Virginia is a world-recognized expert on giraffe anesthesia and has successfully anesthetized numerous captive and wild giraffes. In fact, Dr. Bush authored a chapter on giraffe anesthesia in the third edition of Zoo & Wild Animal Medicine (published in 1993). Was Dr. Bush consulted about anesthetizing this giraffe? If not, why not? Wouldn't it make more sense to bring in the expert from Front Royal, Virginia who is a Zoo employee rather than someone from South Carolina? Exactly how many giraffes had Dr. Lamberski anesthetized and how many giraffe anesthetic events had she participated in prior to July 18, 2001? How much money did the Zoo spend to bring in Dr. Lamberski?
Question line 2: Dr. Bush is not just an expert on giraffe anesthesia; he is also an expert on veterinary medical treatment of giraffes and is the author of a chapter on giraffidae (i.e. giraffes and okapis) physiology and medicine in the fifth edition of Zoo & Wild Animal Medicine (published in 2003). Was Dr. Bush ever consulted about the medical problems of this giraffe? If not, why not? Wouldn't it make sense to consult a readily-available expert on giraffe medicine?
Question line 3: The medical records entry for 18July 2001 states that during the anesthetic procedure, this giraffe was initially given a dose of 90 mg of medetomidine and 1200 mg of ketamine IM; this was followed 20 minutes later by a supplemental dose of 20 mg of medetomidine and 300 mg of ketamine IM. This giraffe was eventually given 3 more 300 mg doses of ketamine IV. Thus, the giraffe was given a total dose of 110 mg of medetomidine and 2400 mg of ketamine. In Dr. Bush's chapter on giraffidae medicine, there is information indicating that, when using a combination of ketamine and medetomidine to anethetize giraffes, one should use a dose of ketamine that is approximately 20 times the dose of medetomidine; this giraffe was initially given a dose of ketamine that was only 13.3 times the dose of medetomidine could that be the reason it did not react to the drugs as desired? What information were Murray, Spelman, and Dr. Lamberski using to calculate the anesthetic drug doses needed? Doesn't it appear that the initial doses of both ketamine and medetomidine were inadequate and that the initial ratio of ketamine:medetomidine was incorrect? Are these things that experts on giraffe anesthesia do? What anesthesia protocol does Dr. Lamberski routinely use to anesthetize giraffes? Is this the protocol that was used on this giraffe?
Question line 4: It is obvious from the medical records entries on 18July2001, that this giraffe did not recover from anesthesia as expected, and that it required seven injections of the anesthetic reversal drug atipamezole over a greater than 12 hour period. In Dr. Bush's chapter on giraffidae medicine, there is information indicating that, to reverse the effects of medetomidine in giraffes, one should give a dose of atipamezole that is approximately 2.3 times the dose of medetomidine. This chapter also states that to reverse medetomidine in okapi, the dose of atipamezole should be 5 times the dose of medetomidine. Thus, to reverse medetomidine anesthesia in giraffidae, one should expect to need to use atipamezole at a dose of 2.3 to 5 times the dose of medetomidine. Since this giraffe was given a total dose of 110 mg of medetomidine, shouldn't Murray, Spelman, and Dr. Lamberski have expected to need to use between 253 and 550 mg of atipamezole? Why was this giraffe initially given a dose of only 100 mg of atipamezole? Is an inadequate initial dose of atipamezole the reason the giraffe stood up 22 minutes after administration of the reversal agent but then fell down 13 minutes later and refused to stand again? Did falling down endanger the health of the giraffe? After the giraffe refused to stand up again for 30 minutes, it was given another 25 mg of atipamezole followed 36 minutes later by another 60 mg. The giraffe then stood up again but the total dose of atipamezole it had received was still only 185 mg. Over the next several hours, the giraffe repeatedly displayed signs of becoming re-anesthetized and was given 4 more supplemental doses of atipamezole (30 mg, 50 mg, 30 mg, 50 mg). Thus, the cumulative total dose of atipamezole that this giraffe received was 345 mg; isn't this within the expected range of 253 550 mg? Why do the medical records indicate that the clinical veterinarians were so surprised that this giraffe needed such a dose? If this animal had been given a proper dose of atipamezole initially (instead of less than half the dose), might it have recovered more normally and not needed so many supplemental doses? Do giraffe anesthesia experts usually need to give 7 injections of atipamezole?
Question line 5: On February 7, the medical records state that "Keeper requests foot x-ray to help diagnose problem of right front foot lameness" and that this foot was then radiographed. Why are animal keepers deciding when an animal needs to be radiographed? Isn't this a medical decision that should be made by someone actually trained in veterinary medicine? What is the competence of a veterinarian who allows untrained lay people to make such medical decisions?
Question line 6: The medical record entries on January 14, 15, and 16, 2002 clearly indicate that the attending veterinarians believed that this giraffe was experiencing digestive problems and that this might be linked to the oral medications for lameness/arthritis (i.e. ibuprofen and MSM). Therefore, the animal was taken off these drugs and the "abnormal eructation stopped". But on February 6, the animal was put back on ibuprofen due to its lameness and the medical records again state that the reason it had been taken off ibuprofen "due to the repeated episodes of abnormal rumination/eructation". Did the clinical vets consider "digestive problems" as the cause for this giraffe severe illness on February 9 (3 days after resumption of the oral ibuprofen therapy)? If not, why not?
Question line 7: On February 11, 2002 (two days after the giraffe died), a reporter (Sylvia Moreno) from the Washington Post contacted the Office of Public Affairs at the Zoo to find out why the giraffe died. At 1:41 pm that day, Spelman sent an e-mail message to Dr. Montali stating: "Based upon your comments this morning, my understanding is that the gross necropsy was not definitive with respect to why the giraffe was suddenly unable to rise. He had severe bloat upon his death, but for a ruminant who is down for many hours, this alone is not definitive as a cause. Do you agree?" Spelman later states in this e-mail "..this is what I would like Bob to tell the reporter: The gross necropsy was not definitive with respect to why the animal was suddenly unable to rise or with respect to the primary cause of death." At 2:25 pm that day, Dr. Montali replied with the following e-mail message to Spelman (copied to me): "Don and I agree the giraffe had developed digestive problems associated with oral and sinus cavity infections. The ultimate cause of death was attributed to a type of irreversible bloat of the forestomachs." At 3:24 pm that day, Spelman sent the following e-mail message to Bob Hoage in the Office of Public Affairs: "Please provide the following information to the Wash Post reporter and any other inquiries: The gross necropsy did not reveal a definitive cause for why the giraffe was unable to rise that morning (Saturday) or why he died. The final pathology report will be available in several weeks." This is the message that was sent to (and published in) the Washington Post.
Was Spelman present at necropsy of this giraffe? Is someone who was not even present at a necropsy qualified to comment on (and change) a report of the gross necropsy findings by two board-certified veterinary pathologists?
Spelman had been told that this giraffe had "frothy bloat" which is a well-recognized and fairly common condition in cattle and other domestic ruminants that veterinary students learn about early in their veterinary education. Doesn't Spelman's statement "He had severe bloat upon his death, but for a ruminant who is down for many hours, this alone is not definitive as a cause" indicate that she does not understand the difference between frothy bloat and regular gas bloat? Wouldn't a competent veterinarian know what frothy bloat is?
Based on the information provided to Spelman by Dr. Montali, was the message that Spelman ordered to be sent to the Washington Post (i.e. "The gross necropsy did not reveal a definitive cause for why the giraffe was unable to rise that morning (Saturday) or why he died.") truthful or is it clearly a lie?
Why would Spelman ignore the findings of two board-certified veterinary pathologists with more than 50 years combined experience in zoo animal pathology? Could the reason for this be that frothy bloat is a treatable condition and that Spelman refused to acknowledge that this giraffe died from something that she and Murray failed to treat? Doesn't the fact that the medical record entries in January and February clearly indicate that this giraffe had a history of digestive problems that were thought to be associated with the oral medications it was on indicate that Spelman and Murray should have readily believed the diagnosis of frothy bloat? Is Spelman's refusal to acknowledge that this giraffe died from frothy bloat probably associated oral ibuprofen therapy (among other factors) due to the fact that it was Spelman who ordered the giraffe placed back on ibuprofen in February 4?
Case #8 Cusimanse (accession #110332; Pathology case #2002-0059)
Case-related documents are: 1) the medical records (pages 8A1 8A3); 2) the pathology report (pages 8B1 and 8B2); 3) a summary of some of the blood chemistry analyses for this animal (page 8C1)
Over the President's Day holiday weekend in February 2002, a male cusimanse was noted to be acting sick and was taken to the zoo's vet hospital. Spelman and Murray were the veterinarians on duty that weekend. The medical records indicate that Spelman admitted the animal to the hospital on Saturday, February 16, 2002 but did not exam it that day. There is no entry for February 17; the animal was not examined that day either. On February 18, Murray notes that the animal looks "scruffy" but she did not physically exam the cusimanse that day, instead she says that the plan is to anesthetize and exam it "within the next few days". On Tuesday, February 19 (the day after the holiday), Murray notes that the hospital animal keeper said the cusimanse had not defecated in the 3 days it had been at the hospital. But instead of examining the animal that day, Murray's plan is to do so the next day. On February 20, Spelman notes that the cusimanse was found dead in its cage that morning.
Therefore, this animal was at the vet hospital for 4 days and no veterinarian examined it during that time.
At necropsy, the cusimanse was found to have advanced renal disease. Because of this, it was so severely dehydrated that the feces in its colon and rectum were dried out to such a degree that they could not be passed, thus causing a fecal impaction; the cusimanse died due to renal disease, dehydration, and fecal impaction. If this animal had been examined sooner, it could have been treated for dehydration and fecal impaction or it could have euthanized. Instead, it was ignored by the veterinarians and left to suffer a miserable death.
Question line 1: If a privately owned animal were admitted to a veterinary hospital by an attending veterinarian and then not examined for 4 days, wouldn't this be an irrefutable case of malpractice of veterinary medicine especially if the animal then died from severe dehydration without having been examined or treated? Therefore, isn't the way this cusimanse was handled once it was admitted to the vet hospital a clear case of neglect and malpractice on the part of both Spelman and Murray?
Question line 2: The medical records show that this cusimanse was given an annual physical examination on March 3, 1998, but then it was not examined again until January 10, 2001. Why did nearly 3 years pass between annual examinations? Isn't this a clear example of incompetence in both veterinary medicine and management of the Department of Animal Health? Who was in charge of the Department of Animal Health during this period of time?
Question line 3: Analysis of a blood sample taken from the cusimanse on January 10, 2001, revealed that the levels of both the blood urea nitrogen (BUN) and serum creatinine were well above normal, thus indicating that this animal's renal function was compromised at that time. Why wasn't this animal given a timely follow-up examination or at least monitored closely? Isn't this yet another example of incompetence or malpractice? Shouldn't Spelman and/or Murray have been suspicious that the cusimanse was in renal failure at the time it was admitted to the vet hospital in February more than a year after blood tests indicated this animal had compromised renal function? Did Murray consider the possibility that the "scruffy appearance" of the animal that she noted on February 18, might be due to renal failure? Isn't a "scruffy appearance" typical of domestic cats and other animals in renal failure?
Case #9 Pot-bellied pig' (accession #109080; Pathology #2002-0306)
Case-related documents are: 1) the medical records for 2002 (pages 9A1 9A5); 2) the pathology report (pages 9B1 and 9B2); 3) the euthanasia request form (page 9C1)
In June, 2002, the veterinary staff was called down to the Elephant House to observe an old female pot-bellied pig. The medical records state that the clinical assessment was that the pig had a "pendulous abdomen" which may be due to ascites. On June 17, 2002, this pig was anesthetized and examined to determine if ascites was the cause for the "pendulous abdomen". Although the "abdomen was tapped", no ascitic fluid was found and neither was any ascites found on radiographs or ultrasound examination.
The next day, I went down to look at the pig; this was done at the request of Murray because she learned that I own an old pot-bellied pig as a pet. My observations at that time were that the Zoo's pig was obviously lame but was otherwise normal; I informed Murray of my assessment and suggested therapy with non-steroidal anti-inflammatory drugs. The next entry in the medical records is on July 1 and states that the animal was to be started on "fatty acid supplement" (not anti-inflammatory drugs). The entry on October 9 states that, although the keepers feel this pig's "abdomen looks bigger", the "keepers prefer not to work up further at this time". The entry on October 17 states that the veterinary staff is considering anesthesia and examination of this animal, but before this can be done "Keepers to discuss and come to a consensus regarding this plan". This pig was not anesthetized until October 24 and during the examination, a mass was found in her abdomen. The medical entry on October 25 states: "keepers have elected euthanasia. We will keep Margo over the weekend with anti-inflammatory meds, good food and a comfortable stall." On October 28, the pig was euthanized and found to have multiple neoplasms in the reproductive tract.
Question line 1: Does the clinical veterinary staff at the Zoo, know what a "pot-bellied pig" is supposed to look like? Aren't there plenty of pictures and other information on pot-bellied pigs available in texts and on the internet? Shouldn't a competent veterinarian know the normal conformation of an animal he/she is supposed to exam --- especially when the animal is a common domestic species? Why did the veterinary staff think this animal might have ascites? Isn't the diagnosis of "pendulous abdomen" in a "pot-bellied" pig tantamount to diagnosing "alopecia" in a "Mexican hairless" dog?
Question line 2: There apparently was no follow-up exam on this animal from June 17 until October 24, 2002 ---- why?
Question line 3: The medical records entry on October 9 states that although there was concern over the health of this pig, the "keepers prefer not to work up further at this time" and thus no work up was done then. The entry on October 17 indicates that the veterinary staff would like to anesthetize and exam this pig --- yet this is not done for another week. The medical records suggest that part of the delay is because the animal keepers needed "to discuss and come to a consensus regarding this plan". Why are animal keepers deciding whether or not medical procedures need to be done? Shouldn't the need for medical procedures on zoo animals be the decision of the veterinary staff?
Question line 4: The medical entry on October 25 states: "keepers have elected euthanasia" and the pig was euthanized 3 days later. Why was this decision left up to the keeper staff? Shouldn't the curator and veterinarians be involved in this decision? What is the Zoo policy/protocol for deciding elective euthanasia in a chronically ill animal? Was this policy followed in this case? The medical records indicate that 3 days passed from the time the keepers made the decision to euthanize this animal and when the veterinarians followed this order. Was a "Request for Specimen Euthanasia" form filled out and signed by everyone necessary before the euthanasia -- as is supposed to happen in a case like this?
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