From dog breeders performing at-home ear-crop surgeries to hydrocodone-addicted veterinary staff members, Dan G. Danner, DVM, has seen some bonafide doozies during his service on the Oklahoma State Board of Veterinary Medical Examiners and the board of directors of the American Association of Veterinary State Boards.
Dr. Danner, a 1978 graduate of Oklahoma State University's Center for Veterinary Health Sciences, was appointed to the Oklahoma veterinary board (OSBVME) in 2003 by the governor and reappointed in 2008, serving two five-year terms.
Before stepping down last year, he served as secretary-treasurer for three years, vice president for two years and president for four. During his tenure, he also served on five committees of the American Association of Veterinary State Boards and spent the last three years on its board of directors.
"In Oklahoma, we've had cases as bizarre as a mixed-animal practitioner whose daughter graduated from veterinary school but couldn't pass the national board exam, yet she worked for her dad for years as a DVM," said Danner.
"This was back in the days when drugs like diazepam and ketamine weren't as closely regulated, and it was harder to trace who was ordering them. When the DVM father was ready to retire and sell the practice, major concerns were exposed because the daughter had been practicing for 10 years without a license."
Not only was the daughter slapped with a major fine, but she lost the opportunity to re-apply for a veterinary license, he said. Practicing without a license has since become a felony crime in Oklahoma.
The Oklahoma Bureau of Narcotics and Dangerous Drug Control's Prescription Monitoring Program, which took effect in 2006, requires scrupulous record-keeping by veterinarians who dispense controlled drugs, and maintains a cross-reference of client use across medical professions, Danner noted.
"Prior to that, we just kept logs in the practice, and it was much more loosely controlled," he said.
In fact, before passage in 2010 of a law allowing non-veterinarians to perform horse dentistry, Oklahoma veterinary board members got wind of an individual who would float horses' teeth for a fee after sedating them with controlled drugs. The term "floating" refers to filing down the sharp points of a horse's molars, a common procedure performed on horses as they age.
"We sent out an undercover investigator to see how far this gentleman would go, and we were very surprised when our investigator asked if he could take pictures of this man doing tooth procedures for his daughter's 4-H project," Danner said.
"He said that would be fine, except for the intravenous sedation, because that was 'very illegal and the Oklahoma Veterinary Board would fine him, so please close the trailer door so that no one can see us,'" Danner said. "So we not only got pictures of him, but confiscated over 13 bottles of controlled sedation drugs just lying on his truck's front seat."
Oklahoma law now provides for non-veterinarians to float horses' teeth, but the practice is licensed by the state bureau of narcotics control and regulated by the Oklahoma Department of Agriculture, Food and Forestry. Any drugs used must be prescribed by a veterinarian under a veterinary-client-patient relationship with the horse and its owner.
Veterinary staff members can be very creative at ways to sneak drugs out or modify drug inventory logs, Danner said.
One example occurred at a clinic that had pharmacy cabinets similar to kitchen cabinets, with the controlled drugs stored in a key-locked drawer.
"First one, then two, then other staffers would simply take out the drawer next to it, and feel around for the bottles they wanted, such as diazepam, and slip out a few," Danner said.
Not So Sweet
One practitioner was particularly sweet and helpful to her older clientele, whose dogs she diagnosed with cancer and prescribed narcotics for them.
"When she came up on the radar of our board, we found that she had over 10 times the normal number of patients, and a major percentage of these had never had cancer," Danner said. In fact, the veterinarian was under-filling the prescriptions and keeping a quantity of tablets for her own consumption, as well as picking up called-in prescriptions to hold in the practice as a courtesy to her clients, he said.
"When prescriptions are filled by a problem employee, some clients may get home with only 50 or 55 out of 60 tablets," Danner said. "These kinds of cases create a huge concern in practices that only do inventory every six to 12 months, as required by their state laws."
The board also encountered and dealt disciplinary action against lay people illegally performing ear-crop surgeries on dogs. One case involved a man obtaining mail-order prescription drugs using an out-of-state deceased veterinarian's name and Drug Enforcement Administration (DEA) number, Danner said, adding, "Our search warrant also found a plethora of stolen items in his home."
In one bizarre twist, Danner said, a human medical doctor anesthesiologist at a Tulsa hospital approached several veterinarians seeking to purchase ketamine, allegedly to perform ear crops on his own pit bulls.
"It turned out that his wife had a 'special K' addiction that he was supporting," Danner said.
Another narcotic case involved a veterinary receptionist who had been prescribed hydrocodone by a human doctor as a pain medication for an injury. When her prescription expired, the woman began ordering hydrocodone elixir as part of the veterinary clinic's drug supplies. This caught the attention of the narcotics board when records showed the clinic had ordered more than 55 gallons of hydrocodone elixir in one year.
"And the veterinarian had no idea what was going on," Danner noted.
Computerized databases maintained by the American Association of Veterinary State Boards, the DEA and state narcotics bureaus have vastly enhanced fraud detection, he said.
"Our investigator can drive up to a practice and get every bit of information needed to do a review or audit, so the electronic age has been an amazing help to keep not only the professionals honest, but the lay people as well who profess to be more than they are."
The Law Won
Beyond the many variations of drug abuse, Oklahoma veterinary board members ride herd on violators of the state's Veterinary Practice Act.
"There are always those days where an individual thinks he can outsmart the law and take major shortcuts to get out of working as hard," Danner said. "It may work for awhile, but mistakes are made and the public or staff will speak out in frustration."
Such was the case of a veterinarian under contract with a large-animal drug manufacturer to market the medical products to a territory of farmers and ranchers.
"That's great when the veterinarian goes physically to the property and examines the animals under treatment, which constitutes a veterinary-client-patient relationship," Danner said.
"But over the years, an aging doctor moved to Arkansas and allowed his Oklahoma license to lapse. He told our board that the drug company had pressured him to continue to cover such a large territory in eastern Oklahoma that it demanded too much of his family time. So, his idea was to just write out any prescriptions that the farmers needed, and he got a major percentage of his sales."
In a board hearing, the veterinarian attempted to justify his illegal practice'which netted more than $235,000 in profits over an eight-year span'by complaining that he couldn't otherwise support his daughter's college tuition and horse-show entry fees, Danner said.
In another case, a veterinarian who graduated from veterinary school in Mexico and was neither a U.S. citizen nor licensed to practice in Oklahoma once set up a spay-neuter-vaccination clinic in a grooming shop in Oklahoma City, Danner said. He was caught and deported after several animals died from simple spays and neuters.
Some non-veterinary owners of grooming shops across the country believe that they can do a dental cleaning or scraping on dogs and cats, giving false confidence to owners that this is sufficient oral health care, he said. Often "special toothpastes" are dispensed to follow up at home, which means those shop owners are practicing veterinary medicine without a license.
With the passage of state legislation outlawing dog- and cock-fighting in Oklahoma, the OSBVME cooperated with state and federal authorities to break up animal fighting rings and their accompanying illegal gambling and narcotics activity. One veterinarian was supplying drugs, suture, IV fluids and more for post-fight animal injury repairs, Danner said.
While blood sampling of animals can be time-consuming and difficult, Danner said, it is better to charge accordingly or decline the business than submit blood from the wrong animal or species, because DNA testing can definitively pinpoint the origin.
In 2008, seven of eight horses presented for auction in Oklahoma and routinely Coggins-tested by a veterinarian for equine infectious anemia came back positive. They were pulled from the sale and quarantined at the owner's property, Danner recalled.
Soon after, the owner re-submitted blood collected by the same veterinarian to the USDA's National Veterinary Services Laboratory in Ames, Iowa, for a group of horses, which included a re-test of the seven who were EIA-positive.
This time, only one showed up positive. The USDA laboratory's DNA results revealed that not only did seven samples come from only one EIA-positive horse, but that blood from only 10 auction horses was used by the veterinarian in multiple vials to make 23 samples, Danner said.
Subsequent screening by the Oklahoma board and USDA of 105 blood samples submitted by that veterinarian showed DNA matches for only 31 horses, he said.
The veterinarian's license was suspended for six months and he was fined $10,000 and was placed on three years' probation.
In another case, a veterinarian substituted bovine blood for a Coggins test on a horse being shipped to Saudi Arabia.
"This has been an ongoing problem with Brucella and tuberculosis testing in bison, antelope, deer and others who are often too flighty and difficult to tranquilize and procure honest blood samples," Danner said. "The University of California, Davis, has also done a wonderful job with DNA testing and pinpointing how many individuals were truly tested, and even what species the blood came from."
Fraudulent blood tests could lead to a re-explosion of deadly animal diseases that state and federal officials have worked so hard to contain, he said.
"It's absolutely important to animal and public health."
While vaccines, heartworm preventive products and medications "on the cheap" are increasingly available from non-clinic settings, the fact remains that medical testing, administration and handling of vaccines and prescribing of medicine for animals are all governed by the Oklahoma Veterinary Practice Act. Danner said board members will do what's necessary to protect the public.
A Texas corporation recently was hiring Oklahoma-licensed veterinarians to administer vaccinations and dispense prescription heartworm prevention and flea and tick products from the parking lot of a national-chain drug store under an open, 10-foot square tent, Danner said.
"They would open for the weekend, and then move on, making it hard to catch them. The Oklahoma Veterinary Practice Act requires DVMs to be available post-surgery or -treatment for any needed follow-up care," he noted. "It was also a violation of many practice or hospital building codes, as the group only used a tent top, with no sides. Does the possibility of a runaway pet in the middle of a high-traffic intersection concern anyone?"
Sometimes veterinary assistants who believe they know the mechanics of medicine but lack proper credentials to practice step over the line.
"One staff member set up rabies vaccine clinics in Walmart parking lots in the large city areas, falsified the rabies certificates and even began making diagnostic remarks and treatment suggestions as his confidence grew," Danner said.
Two years after graduation from veterinary school, Danner in 1980 opened Animal Medical and Surgical Hospital in Tulsa with the aim of practicing medicine. When approached to serve on the State Veterinary Board, he contemplated the idea, accepted it and threw his heart into the role.
"We're here to help people," he said of the veterinary board. "The best veterinary boards are the ones that have the least number of complaints.
That means they have educated the licensees and done it well. If everyone's failed the test, then the teacher must be the problem'not the students."
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