VCA Regional Correspondence

Dear Mr. Yingling,

First and foremost, let me express my own very heartfelt sympathy on your loss of Herb, and for what you and your family have gone through. I can only imagine the hole that he leaves behind.

I really appreciate all that you've brought forward in terms of your experience with VCA EAHRC, both historically and during Herb's most recent care. Feedback like yours is not easy to receive, but it's important to hear. I understand your feeling of being let down during a time when you should have felt supported, informed, and confident in the care being provided. For that I am truly sorry, and I take it very seriously.

In response to the concerns you raised, the leadership team at VCA EAHRC has taken actionable steps to resolve issues in both our processes and your experience. Specifically, we've instituted additional training to reinforce previously established clinical standards and expectations for patient care, including: ensuring outside records are consistently stored in a standard location, with a defined process for documents that fall outside the usual workflow; reinforcing expectations for evaluation, monitoring and maintenance of catheter sites, as well as overall patient cleanliness; strengthening client communication, including timely responsiveness to questions and concerns; providing staff education on dietary alerts within the patient care record, and a specific protocol to include owner-directed feeding instructions in the medical orders.

You raised a concern about Dr. Cahn's not having access to the complete medical records when he took over Herb's care. That was a process failure, and since then the issue has been identified and corrected as described above. At the time, Dr. Cahn's team worked to (re)obtain the missing records from outside practices as quickly as possible so they could move forward with the most complete information available, but I recognize that doesn't change the frustration and distress caused in the moment.

You also asked why Dr. Cahn didn't directly contact the doctors at Kensington Veterinary Hospital after Herb's admission. In most cases, the primary form of communication between veterinary teams is the medical record itself, and in Herb's case those records did help guide treatment, including the use of the same antibiotics that he had responded to in December. And your point about the need for direct communication is a fair and important one. Dr. Cahn then provided a summary letter to KVH following his assessment and treatment of Herb on March 12.

I also want to acknowledge directly your concern about Herb not receiving his specialized diet. That should not have been missed. At the time of Herb's hospitalization, a new system had recently been implemented and the dietary alert was overlooked. While I hope this explains how it happened, it clearly does not excuse the mistake nor lessen the impact it had on your trust or experience.

After initially improving, Herb experienced a sudden and significant decline on March 13. He developed dark black, tarry stool (melena) indicative of bleeding within the upper GI tract, and became significantly painful and progressively, severely nauseous. At that point the clinical concern was for intestinal ulceration and the possibility of active or impending perforation of the intestinal tract given the speed and severity of his deterioration.

In light of those findings and changes, the prognosis for Herb to have a meaningful response to treatment was considered guarded to poor. That assessment was based not only on the acute and severe change in his clinical status, but also in the context of his broader medical picture — the recurrence of a significant liver abnormality (hepatopathy) of unknown origin, along with progressive systemic signs since February including panuveitis, limb swelling, a draining tract, bruising, and thrombocytopenia. As veterinarians, it is our responsibility to explain prognosis as clearly and honestly as possible so families can make informed decisions about whether to continue medical treatment.

I know none of this erases the parts of your experience that left you disappointed in and unable to trust us. Again, I am truly sorry for that. Regardless of intent, stress and distress were added at a time you should have felt supported. In recognition of that experience, and as a good faith gesture, I would like to offer reimbursement for the second and third days of Herb's hospitalization in the amount of $4,419.94.

Once again, please accept my deepest sympathies on your loss of Herb. My heart goes out to you and your family.

Dear Mr. Yingling,

Thank you for touching base again, and I must apologize. I found my response to your last email in my draft folder this morning, when I had been sure it was sent last week.

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Dear Mr. Yingling,

Thank you so much for sharing the pictures. It is very clear how special, deeply loved, and important Herb was. I am sorry I did not have the chance to meet him.

I will do my best to answer your questions here, though I do think a phone conversation may be the best next step, as it may help ensure I fully understand your concerns and can respond to them as clearly as possible.

As I shared in my first email, I absolutely acknowledge that there were aspects of this experience where things fell short of the standards to which we hold ourselves. I am truly sorry for that.

While we do not have a definitive diagnosis or single answer for Herb's decline, I would respectfully disagree with the conclusion that this was "allowed to spiral." While Herb's condition did worsen during his hospitalization, our understanding is that his body and underlying illness were progressing despite treatment, most likely related to his gastrointestinal ulceration, with the possibility of other systemic factors contributing as well.

I was not personally present for the conversations you had with Herb's doctors, so I cannot speak to the exact wording used at the time. Based on your description and the medical record, my understanding is that the "Hail Mary" terminology was intended to convey the seriousness of Herb's condition and the poor prognosis, rather than to suggest that there was nothing more that could be done.

In terms of possible next-step treatment, the medical record reflects that extended hospitalization with aggressive treatment for a possible ulcer remained an option. In general terms, that would have included continued hospitalization, medications to address pain and nausea and to support ulcer healing, close monitoring for any signs of perforation that could have required emergency surgery, and ongoing assessment of his vital signs and blood work.

With regard to communication with KVH, it would be uncommon for the treating doctor to place a separate call if the relevant information had already been conveyed through the medical records. In this case, the records provided by KVH appear to have included Herb's history, prior response to treatment, and clinical course, and that information was available to help guide treatment decisions.

Regarding reimbursement, the offer being extended is intended as a good-faith acknowledgment of your experience and of the portion of the hospitalization where we recognize the experience did not meet expectations. For that reason, the offer does not extend to the entirety of the hospitalization.

Once again, I am so sorry for Herb's passing, for the loss you are carrying, and for the parts of this experience that added to your pain.

Dear Mr. Yingling,

I appreciate you sharing your position, and please know your thoughts are heard. I have done my best to respond to your questions and concerns, and don't believe there is more I can add at this point.

In regard to your reimbursement request, our offer does not extend to the entirety of the hospitalization costs, but I am happy to facilitate the $4,419.94 reimbursement as mentioned previously if you choose to move forward with that.

Take care,