[A preliminary explanation: The Center for Avian & Exotic Medicine is a veterinary practice associated with the more conventional dog-&-cat Animal General practice in the same block of New York's fashionable West Side. The Wild Bird Fund, a charity distinct from both for-profit veterinary practices, is nevertheless closely associated with them, using common facilities and accessing the same pool of veterinary expertise. When a bird I rescued, seen initially at Animal General by Wild Bird Fund staff proved unsuitable for release, she was subsequently seen as a “private patient” by staff at Center for Avian & Exotic Medicine. This ultimately led to excessive reliance on the complex infrastructure of the associated operations, under largely common management of Karen Heidgerd (practice manager) and her protegé, Lorelei Tibbetts (variously, practice manager managing the avian practice or hospital manager). When my very sweet and special darling, Sunshine, became very ill, a series of medical mistakes, beginning with the onset of nosocomial pneumonia and followed by inept care in the hospital area, especially by unlicensed, poorly trained, poorly supervised merely “paraprofessional” workers — the direct management responsibility of Tibbetts — Sunny died in pain and fear. The sole acknowledgement: a modest bouquet of flowers and a word of condolence. I am told the florist that supplies the modest bouquets does a brisk business with the Animal General family of veterinary practices.
After careful thought and some study, I concluded that Sunshine's death was possibly preventable, and that certainly the manner of her passing — unneeded pain, unneeded fear, effectively an inhumane death in brutal circumstances — could have been avoided. The culprit, as it seemed to me then and still does, was the person managing the avian & hospital operation, Lorelei Tibbets. She allowed what she perceived as business goals to supervene good veterinary treatment. I have subsequently come to believe, upon conversation with others familiar with the operation, that this callous perspective may even have arisen higher up the management chain, from her mentor, Heidgerd.
This preference for the merely petty over the welfare of animals even can be seen as pervading the nominally charitable “giving back” in support for the Wild Bird Fund (of which Heidgerd is an officer).
With this in mind, six months or so after Sunshine's life was snuffed out at the Center for Avian & Exotic Medicine, I filed the following complaint with the New York State Education Department, Office of Professional Discipline. It is, of course, just a complaint....]
COMPLAINT AGAINST LORELEI C. TIBBETTS, LICENSE #004299
I believe the record of Ms. Tibbetts, evidenced especially in the death of my pet bird, Sunshine but not limited to that set of events, will show violations of the following Professional Practice Guidelines for veterinary professionals, as promulgated by the New York State Education Department, Office of the Professions:
Guideline 5.2, requiring honesty and integrity: Ms. Tibbetts was patently dishonest.
Guideline 5.4, non-interference with the sound judgment of a veterinary professional: Ms. Tibbetts (a technician merely) appears to have regularly meddled in decisions being advanced by veterinarians caring for various of our birds.
Guideline 5.7, anent professional standards of humane care and treatment: Ms. Tibbetts. in her own person and in failure to exercise due diligence in the supervision of both professional and unlicensed staff under her direction, did not provide human care and treatment.
Guideline 5.10, specifying that no layperson, corporation or other entity be allowed to exploit the relationship between veterinarian and client: Ms Tibbetts, either then a part-owner of the practice where she worked, or in the process of achieving that role, took steps to inappropriately enhance the position of the business to the ultimate detriment of patient care.
Background
Tibbetts is variously described as “practice manager”, “hospital manager” and part-owner of The Center for Avian & Exotic Medicine (hereinafter “CAE”), a specialty veterinary practice associated through common ownership with Animal General, a conventional dog-&-cat veterinary practice located on the same block in Manhattan. Other principals appear to include Paul Howell, D.V.M., and Karen Heidgerd, both more fully engaged by the antecedent Animal General practice. Animal General is also the support facility for Wild Bird Fund, Inc., a not-for-profit tax-exempt organization offering rehabilitation support for the wild and feral city avian population, and limited services for other urban wildlife. [Each of these has its own website, generally informative and not particularly inaccurate, while still serving a promotional purpose.]
Our companion birds have been seen at CAE from roughly January 2007 through March, 2010. Primary veterinary care was provided by Linda Pesek, V.M.D., DABVP (Avian), considered an expert on our birds' species, from the initial connection until her tenure at CAE was terminated for unspecified business reasons. Dr. Pesek's responsibility was taken over by Simon Starkey, B.VSc., Ph.D, DABVP (Avian). Additional veterinary care was provided by Alexandra Wilson, D.V.M., whose primary interest is in reptiles (not yet a board-certified specialization), but who has wide avian experience and who enjoys a reputation as a superior veterinary surgeon, especially in small, delicate avian and exotic animals. Drs. Pesek and Starkey now practice elsewhere (we continue to engage their professional services in looking after our companion birds). I believe Dr. Wilson remains engaged part-time at CAE.
Particulars Leading to the Death of Sunshine
Sunshine was our special darling, a 2½ year old bluebar pigeon. She had lived with us since just fledged, and having been for some time our only companion bird, had developed companionable habits quite out of the ordinary and consistent with constant association with human beings. She was the senior hen of the “house flock” and a remarkably sympathetic little bird. Dear as our other birds are to us, she has proven a completely irreplaceable part of our household.
On March 1, 2010, Sunshine was vomiting and having clear gut problems. This was not unknown; she had had similar problems in the past, associated with “pigeon grit” (the rather coarser grit served pigeons along with seed). These problems had been resolved through a dietary change to pelleted food (no grit needed), so the clear indication was that something was amiss. We made an appointment for Sunshine at CAE.
On March 2, Sunshine received a comprehensive diagnostic examination include a radiograph. This disclosed the problem: Sunshine had gotten at Mrs. Jenner's desk, had eaten several small decorative beads and a few staples. The last — some open, therefore sharp, and all zinc-coated — were particularly troubling. Sunshine was checked in to the CAE hospital, with surgery scheduled for the next day.
The scheduled proventricular surgery was performed late in the day. This is surprising, since it had been made clear this was considered not inconsiderable intervention; one would have expected the manager (Tibbetts) to schedule this surgery when the veterinarians (both Drs. Starkey and Wilson) were freshest. The surgery was estimated to require 1½ hours; it lasted an hour longer, suggesting that whomever was responsible for seeing that needed equipment was on hand had not done so. The surgery was, in fact, only partly successful. Some of the foreign objects were successfully extracted; some remained.
For reasons that are unclear, hospital staff commenced gavage feeding on March 4. This is surprising, since Sunshine had always shown good appetite even when unwell. When visited at this point during her hospitalization, she would gladly accept food and treat titbits. One is inclined to speculate that gavage feeding was at least as much a matter of convenience as of clinical necessity. Other puzzles obtain: The record shows that feeding was “>500g”; pigeons normally consume 50g-75g (depending largely on environment; cf: inter alia Johnston & Janiga, The Feral Pigeon). It is not clear what formula was used in this feeding; most commonly available liquid formulæ are relatively high in protein for adult birds (based on e-mail exchange with Diane Winn, Ph.D., a recognized avian nutritionist). Conversation with Tibbetts suggests that rigid crop needles are commonly used at CAE for gavage, rather than softer, ostensibly safer red-rubber catheters. The importance of this last element becomes apparent in the next paragraph.
On the morning of March 5, Dr. Wilson performed an ingluviotomy, to remove foreign objects that had not passed from Sunshine's crop. I was at a client site that morning; Dr. Wilson telephoned to tell me of the second operation, that it had been entirely successful and that Sunshine was doing well. She was completely optimistic in her conversation with me.
[NB: The probity of using rigid crop needles after this procedure seems to me strange and even outré. If gavage was in the hands of less expert, unlicensed and nonprofessional staff, the decision to feed this way is even less justifiable. Other handfeeding modalities exist, though they demand more time and attention.]
On Saturday and Sunday (March 6-7), we visited Sunshine in hospital. She was clearly tired, but not in dire circumstances. Dr. Starkey was optimistic in comments to Mrs. Jenner and me.
On March 8, I went to CAE to visit Sunshine. An unlicensed member of the CAE staff brought Sunshine to the examining room where we were to visit. Sunshine was wheezing, with crackling breathing — clearly labored, and obvious signs of pneumonia. When Dr. Starkey came in very shortly after, I showed him this; Dr. Starkey was patently surprised and quickly confirmed the breathing problems as classic symptoms of pneumonia. It was entirely clear that the hospital staff supervised by Tibbetts had either failed to note these obvious symptoms of pneumonia or, having noticed, failed to bring this to the attention of any of the veterinary staff, and apparently, had not even noted the matter on Sunshine's chart. This pneumonia continued for two days and in combination with shock from a last treatment (preparatory to transfusing blood from another of our birds, Sunshine's offspring), was the direct cause of her death on March 10.
Interestingly, the bill for services shows that CPR was administered a day after Sunshine died, and we were billed for this apparently post-mortem procedure.
Egregious Violations
It is from March 8 that truly egregious violations of promulgated veterinary practices noted previously begin, and these were clearly orchestrated and conducted by Tibbetts, in her capacity as manager and (either then, or immediately after) part-owner of CAE.
Tibbetts
sought to claim this was aspiration pneumonia. However, given
Sunshine was already weak from two operations, chelating medications
and on-going antibiotic treatment, survival with aspiration
pneumonia for three days (at least) is unlikely. Given the broad
spectrum antibiotics being administered, the most obvious
possibility is nosocomial viral pneumonia. This is consistent with
various clinical descriptions.
[Morover, aspiration pneumonia
is frequently a result of regurgitation, some of which would have
found its way to the cage bottom. Were this the case, then Tibbetts
and the staff she supervises would be even more obviously at fault;
the vomitus
should
have been noted and reported to Dr. Starkey, or in his absence
another staff veterinarian for immediate action.]
Tibbetts sought to deny her staff's and her own responsibility. This is not consistent with the obvious character of the symptoms Sunshine presented; it is not consistent with the constant monitoring expected in an “hospital” setting, especially in the case of very seriously compromised little bird. Tibbetts's unlicensed nonprofessional staff should at least have noticed these symptoms and brought them to the attention of the veterinarian charged with Sunshine's care. Professional staff — most especially Tibbetts herself, in her capacity of “hospital manager” — should have seen the symptoms and reported them to Dr. Starkey. That I should discover this as well advanced, full-blown pneumonia is indicative of both direct negligence and failure in effective supervision of unlicensed nonprofessional staff.
Tibbetts managed to be involved in all professional conversations with Dr. Starkey on-site at CAE, after the obvious hospitalization failures leading to exacerbated, presumably nosocomial pneumonia. Considering that Tibbetts was Dr. Starkey's supervisor at CAE, and the nature of those interviews, this had a chilling effect on the veterinarian/client relationship. It most likely includes at least tacit interference with the professional judgment of the veterinarian in charge of Sunshine's care.
In retrospect, it is clear even to me (a layman) that the onset of nosocomial pneumonia is almost certainly fatal (in fact, I thought this at the time, but was encouraged to believe otherwise by allegations of possibly effective treatment from Tibbetts et al.; vid. supra #3). The best course for Sunshine, and the only course consistent with her felicity, would have been to secure such palliative medication as was prudent and available, then to bring her home to die peacefully in familiar surroundings. Tibbetts's ongoing support of the idea that further procedures would be successful resulted in Sunshine being deprived of a peaceful end in familiar surroundings. This is clearly inhumane treatment (and it is also patently immoral in the strict technical sense, an exercise of Tibbetts's personal interest subverting concern for Sunshine's happiness).
Items 3 and 4 suggest that Tibbetts's concern for the good of the business trumped her concern for the greatest felicity of our bird Sunshine. When coupled with apparent negligence in caring, both direct and in her supervision of other staff, it shows a pattern of neglect, and dubious moral character (cf: Kant, Metaphysische Anfangsgrunde der Tugendlehre, passim, especially Ethische Elementarlehre, as I recall).
I note in passing, other clients of CAE have told me that, especially with Dr. Starkey's departure from the CAE practice (leaving the practice without a board-certified specialist in avian medicine), they choose to withdraw their patronage. Inevitably, dissatisfaction with Tibbetts as a veterinary professional figures among their reasons.
I also note that one of the principals of the Wild Bird Fund, which has occasion to use the Animal General / CAE hospital facilities, has opined privately that the overnight hospital care — presumably within Tibbetts's purview — is generally less than satisfactory.
It is not claimed that Sunshine would have survived had Tibbetts acted otherwise; that cannot be known one way or the other.
It is most especially not the claim that the veterinary staff engaged in Sunshine's care were culpable. At the time and since, I have reposed complete confidence in Dr. Starkey and Dr. Wilson (and in Dr. Pesek, who was, of course, not involved in this matter, but had been employed at CAE previously). I continue to value Dr. Starkey as a competent professional, and have taken birds to him for care since he has left CAE. His untrammeled clinical judgment, coupled with sound scientific capability (which, as an Academic and university teacher, I am able to assess) is entirely reliable. What I know of both the professional and the person leads me to believe that such mistakes as I believe were made happened in large measure because he and his professional colleagues were ignored at crucial moments.
What is claimed is simply that Tibbetts both directly and as hospital manager supervising (unlicensed, merely paraprofessional) staff failed to note and take action when Sunshine developed a secondary problem, that Tibbetts failed to notify the attending veterinarian of that secondary problem, that Tibbetts attempted to divert attention from failures both personal and systemic stemming from personal failure which possibly led to the second problem and certainly exacerbated it by delaying proper treatment, and that for merely business reasons misled us and encouraged protracted treatment and procedures which caused Sunshine additional and unnecessary pain, leading to death, and in the manner of that death, denied her a peaceful end.
In short, there is sufficient ground, in the case of our bird Sunshine's death, to impeach Lorelei Tibbetts (this summary), meriting an Office of the Professions general inquiry into her performance as a licensed veterinary technician along the lines suggested above, and if confirmed in any particular, to impose appropriate discipline.