ARIZONA STATE VETERINARY MEDICAL EXAMINING BOARD
1740 W. ADAMS ST., SUITE 4600, PHOENIX, ARIZONA 8509

VETBOARD.AZ.GOV

COMPLAINT INVESTIGATION FORM

lf there is an issue with more than one veterinarian please file a
separate Complaint Investigation Form for each veterinarian

PLEASE PRINT OR TYPE

FOR OFFICE USE ONLY

Date Received: Jan ‘ lp HOA Case Number: Ada-FB

A.. THIS COMPLAINT IS FILED AGAINST.THE FOLLOWING:
Name of Veterinarian/CVT: _Dr John Montana.
Premise Name: West Olive Animal Hospitat LLC

Premise Address: 10651 W Olive Ave #100, Peoria, AZ 85345:
City: Peoria State: AZ Zip Code: 85345
Telephone: (623):334-4121

City: = State: lip Code: aay

-Home Telephone:___ CSCC Tele ttn ce:

*STATE LAW REQUIRES WE HAVE TO DISCLOSE YOUR NAME UNLESS WE CAN SHOW THAT DISCLOSURE WILL
RESULT IN SUBSTANTIAL HARM TO YOU, SOMEONE ELSE OR THE PUBLIC PER A:R.S. § 41-1010. IF YOU HAVE
REASON TO BELIEVE THAT SUBSTANTIAL. HARM WILL RESULT IN DISCLOSURE OF YOUR NAME PLEASE PROVIDE
COPIES OF RESTRAINING ORDERS OR OTHER.DOCUMENTATION.

C. PATIENT INFORMATION (1):
Name: Jackson
Breed/Species: English Mastiff
Age: 13 months Sex: Male Color: Fawn

PATIENT INFORMATION (2):

Name:

Breed/Species:

Age: __ Sex: COMO

D. VETERINARIANS WHO HAVE PROVIDED CARE TO THIS PET FOR THIS ISSUE:
Please provide the name, address and phone number for each veterinarian.
Dr John Montana 623-334-4121

Dr Shawna Wood _.928-853-9756
‘AZ VetMed Emergancy 602-697-4694 .

E. WITNESS INFORMATION:
Please provide the name, address and.phone number of each witness that has
direct knowledge regarding this c eae che
Gary Jack Tolmachoff, = = ae
Elaine Craven
Jacob Faulkner -'
Janie Petramala ‘3

Attestation of Person Requesting Investigation
“By signing this form, | declare. that the information contained. herein is true
and accurate to:the best. of my knowledge. Further, | authorize the release of

any ‘and_-all’ medical records or.information necessary to scemipiere the _
InvesHganOn of this-case.

Signature:

Date:

F. ALLEGATIONS and/or CONCERNS:
Please provide all information that you feel is relevant to the complaint. This
portion must be either typewritten or clearly printed in ink.

11/19/2021 placed call to Dr Montana: Jackson not eating, and lethargic Did not speak
to Dr made appointment ;
11/23 Blood work taken talked to Dr Montana about my concerns with Jackson and
reminded him we had just put down a dog a few weeks prior with same symptoms. Dr
Montana's decision was to draw blood and do a full blood panel to determine Tick Fever
or Valley Fever.
11/24 8:15 8:38 call for test results left message no return call back
41/29 5 days later 8:20 call for test results left message no return call back
11/29 8:33 call for test results was told by front desk Jackson tested positive for Valley
foe titer 1:16 | asked what does that mean, was told Dr Montana would call back and
iscuss.
11/29 12:05 12:10 12:23 called to speak with Dr left message on answering machine
11/29 12:54, 12:59, 1:00, 1:02, 1:12 called to see if they would pick up the phone the
phone continued to go to voicemail. no return call
11/29 1:20pm spoke to front desk who advised me they would be putting Jackson on
1620 mg per day of Flucanazole. | questioned the dosage thought that was alot. At this
time | was told by the front desk to start contacting compounding pharmacy to see who
could/would be able to fill the prescription. | contacted several pharmacy's not sure what
to ask for as | am not the veterinarian and no way competent to ask or how to ask for a
drug and if they can fill it. Several calls were made to Dr Montana's office on this subject
after 1:20pm times of call back were, 1:43 no answer, 2:10 no answer, 2:25 no answer,
2:39 no answer, 2:57 left message on machine no call back, 3:11 left message no
answer.
11/30 9:27 am called spoke to front desk advised me they had called Potters House and
they would be filling Jacksons prescription, | asked to speak to the Dr as he had not
called me back from 11/23 on Jacksons test results. TO DATE 1/6 | have still not spoken
to Dr Montana about Jacksons test results or care or well being.
11/30 4:54 | received a call from the vet tech stating Dr Montana had left for the day and
he didnt want me to go another day with out knowing Jacksons test results. Vet tech
was not able to answer my questions on Jacksons test or need to supply Jackson with
alternate help for his appetite or help could assist Jackson fighting this disease.
12/1 8;25 9:00 10:15 calls to the office want to speak to dr about Jackson and advising
the front desk Jackson appetite was diminished and | needed help with this, asked if |
could put Jackson on entyce which the front desk advised yes. At this time | put a reques
in for entyce at Petco as it is a prescription for 10mi Dr Montana again filled the
prescription for 30m without a phone call to me to check on Jacksons progress or what
was going on with Jackson.
12/15 12:50 3:25pm called and left message Jackson was very sick and needed to
speak with Dr Montana thinking Jackson had pneumonia _ no call back
12/16 10:36 10:59 called and left message stating thinking Jackson has pneumonia, at
this point | took Jackson at 3:30 to Dr Wood who took over taking care of Jackson who
did confirm he had pneumonia.
Pe Montana's office called at 3:45pm that day and stated. Dr Montana had left for the
ay.
re yl HAS NOT REACHED OUT TO ME ON JACKSON SINCE THE VISIT
Dr Wood took over Jacksons care who treated him for pneumonia for 10days. He was
pee transferred to the VetMed for urgent care where he stayed for 4 days and lost his
attle.
Please. look into the negligence and lack of urgency of Dr Montana's behavior. Had Dr
Montana taken the time needed to help Jackson the outcome could have been very
different for my boy. | am asking all of Jacksons medical bills and care during this period
be the sole responsibility of Dr Montana.

Rov 8.14.17

é Statement from Dr. John V. Montana

_ [first initially examined Jackson on Monday, November 22" for lethargy,
decreased appetite, and feverish on exam (temperature 104 degrees Fahrenheit).
The owner was concerned with causes such as poisoning, due to the loss of a
previous pet in the past. No signs of toxicosis were evident. A comprehensive
blood panel was submitted. | prescribed 300 milligrams of Doxycycline every 12
hours due to the fever as well as an injection of 12 milligrams of Dexamethasone.
The owner declined the Doxycycline until test results were received. On
Wednesday, the owner called in with the history that the patient was coughing
with nasal congestion. The partial results revealed mild anemia, neutrophilia, and
more substantial monocytosis. Valley fever results were still pending. We started
the patient on Doxycycline. After the Thanksgiving holiday, in where we were
closed, the valley fever results were obtained as positive with a titer of 1:16. My

_Staff was informed to call the client and starting Fluconazole was ordered by the
doctor. The owner, through my staff, wanted to find her own compounding
pharmacy for the medication, which would be more convenient to pick up
medication. The receptionist helped In finding a location to call in the
prescription. My staff member, Steven, answered questions about titer numbers
and how they are used in the treatment of valley fever. The owner seemed
satisfied with hls explanation, which occurred on November 30“, 2021. The
owner was interested In using Entyce to help the patient’s appetite. | was fine
with that decision and approved its use. On Thursday, December 16", my

2|Page

receptionist emailed bloodwork results to the owner. No communication since.
The bloodwork performed in November never reflected any indication of renal
disease or failure. The mild anemia and monocytosis was contributed for the time
being as secondary to chronic and/ or valley fever disease. No follow up was done
since the owner left the practice. Phone conversations were done by the support
staff and the owner. The staff Is very good and competent in explaining and
adhering to my recommendations. They are also very reliant on informing the
doctor If | need to call the owner directly to answer questions or further concerns.
The owner expressed satisfaction with their explanations. The owner was -
reluctant to have ongoing rechecks in the office for the patient, and did not
always comply with doctor recommendations, such as starting Fluconazole or
Doxycycline initially. The report received from Vet Meds on Thursday noted a
December 15" recheck. A recheck appointment on this date was not done at
West Olive Animal Hospital when the patient was put on Clavamox and Previcox.
The acute renal failure was new. West Olive Animal Hospital does not supply or
‘store Previcox.as a drug, so getting the prescription is:unknown to us. As far as
West Olive Animal Hospital.and Dr. Montana concerns,'the patient had- valley
fever and was being treated accordingly. This facility does not ignore. peoples lack
of knowledge or:understanding of medical conditions, but itis not always feasible
to have all questions answered directly by the.doctor. We accommodate recheck
‘examinations,:appointments, and ongolng clinical issues and-will assist:owners to
other alternatives if we are unable to accommodate owners. For example,
ihc

‘emergency clinics, Midwestern University, AVECCC, etcé
Co. Y Mortar dv

, 093-334-412]

VICTORIA WHITMORE
- EXECUTIVE DIRECTOR -

DOUGLAS A. DUCEY
- GOVERNOR -

ARIZONA STATE VETERINARY MEDICAL EXAMINING BOARD
1740 W. ADAMS STREET, STE. 4600, PHOENIX, ARIZONA 85007
PHONE (602) 364-1-PET (17738) * FAX (602) 364-1039
VETBOARD.AZ.GOV

INVESTIGATIVE COMMITTEE REPORT

TO: Arizona State Veterinary Medical Examining Board

FROM: AM Investigative Committee: Robert Kritsberg, DVM - Chair
Christina Tran, DVM
Carolyn Ratajack
Jarrod Butler, DVM
Steven Seiler

STAFF PRESENT: Tracy A. Riendeau, CVT — Investigations.
Marc Hanis, Assistant Attorney General -

‘RE: Case: 22-73
Complainani(s): Melodie Faulkner
.Respondent(s}: Jonn-Montana,.DVM (License: 1870}

SUMMARY: APPLICABLE STATUTES AND RULES:
Complaint Received at Board Office: 1/6/22 Laws as-Amended August 2018
Committee Discussion: 6/7/22: (Lime Green); Rules as. Revised September
Board IIR: .7/20/22 2013 (Yellow):

On November 22, 2021, "Jackson," an approximate :1-year-old: male English: Mastiff was
presented to Respondent for lethargy and anorexia. The dog was febrile and blood was
collected for testing. A couple days later, it was documented in the medical record that the
dog began.coughing and:had nasal congestion therefore: antibiotics were dispensed.

On November 29, 2021, Complainant was advised that the dog was positive for Valley Fever
and fluconazole was. prescribed. A.couple days later, Entyce was dispensed: due to the dog
continuing to be inappetent.

Complainant had not:spoken to Respondent:since the initial exam regarding the dog's
condition or.blood results.

On December 15, 2021, the dog: was presented to Dr. Wood at Legacy Veterinary. Services
for asecond opinion. The dog was febrile and had pneumonia —antibiotics were dispensed. The
dog's condition waxed and waned: he was treated with SQ fluids, Previcox, and: holistic
therapies.

On December. 29, 2021,.Dr. Wood repeated blood: work which:revealed the dog:had:a
severely elevated kidney values. The dog was administered IV. fluids and ozone therapy: referral

22-73, JOHN MONTANA, DVM

to an emergency facility was made.

On December 30, 2021, the dog was presented to VETMED for evaluation and
hospitalization. The dog was diagnosed with renal failure and was hospitalized for treatment
and supportive care.

On January 3, 2022, due to the dog's guarded prognosis, he was humanely euthanized.

Complainant was noticed and appeared.
Respondent was noticed and appeared telephonically. Attorney David Stoll appeared.

The Committee reviewed medical records, testimony, and other documentation as described below:
e Complainant(s) narrative: Melodie Faulkner
e Respondent(s) narrative/medical record: John Montana, DVM
e Consulting veterinarian(s) narrative/medical record: Legacy Veterinary Services; VETMED

PROPOSED ‘FINDINGS of FACT’:

1. On November 22, 2021, the dog was presented to Respondent due to lethargy and anorexia.
Respondent stated in his narrative that Complainant was concerned the dog was poisoned
due to the loss of a previous pet in the past. Complainant denies that she was concerned the
dog was poisoned. The dog had a weight = 153.4 pounds and a temperature = 104 degrees; no
heart rate or respiration rate was noted. Respondent documented heart, lungs good; lungs
clear. No tentative or definitive diagnosis documented. He recommended blood work,
Doxycycline and an injection of dexamethasone. Complainant approved the blood work and
dexamethasone but declined antibiotics at that time. The dog was administered 15mg
dexamethasone IM and was discharged. Complainant and her friend, Mr. Tolmachoff, denied
that antibiotics were offered.

2. On November 24, 2021, Complainant stated she called to get test results but did not get a
call back. According to Respondent's medical records, Complainant called to report the dog
was coughing and had nasal congestion. Complainant denies she reported the dog was
coughing. Partial lab results were back and revealed mild anemia, neutrophilia, and more
substantial monocytosis. Respondent dispensed Doxycycline 100mg, 30 tablets; give 3 tablets
orally every 12 hours.

3. After the Thanksgiving holiday, Respondent's premises was closed.
4. On November 29, 2021, Complainant stated she called to get the Valley Fever results. She
was advised by staff that the test was positive with a titer: 1:16. Complainant was told

Respondent would call her to discuss. Respondent did not return Complainant's call.

5. Blood results as follows:

Page 2

22-73, JOHN MONTANA, DVM

funni annie (ent Uden)

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Meet i . ———— | Creetone oe 08.1.8 mga —T—
Wsetarte stan i? ' on SS @uN cry 9-31 age —=——a=
uev n m-7e8 —rr—> use Creatine (07
ucn m2 219-28.190 —

Protgmenve ar 25-01 ght. ——r—
3 TS
McCue ms 320-322 gd, Calurn 1m ene | Co
‘6 Retcatocps aa * soaun 142 ae | Coo)
Reticutocytsa Ty 10-110 ph es | a | Potreslun 4s 4D-B4emon. [A ee S|
Redoutocyts 333 245-31.8 09 SS wr K Reto. 32 m3? aT
ened ; oes Clonee tte |
_ ae ates —— reo 2 ee
‘% Neuroptilis m2a7 as (Bicarbonate)
WL yespnecytes 140 * ‘Arten Gap 7 11-28 emnlt. — So
8 Monacytes tar * Tota Peete eo 05-7. gm —=—_—
‘tui as 7 thane Y =——————
‘% Bescphits ar * Gieman as 24.4098, Sr)
esis seeet oo es | Woes, Pe —
= Lymphocyes 24n2 1.08 - 4.03 Kp. 1 aT 7 19. 420uA [ es eS
Pra iope ia | en se oe | 4 ast 2 10-65u8 ——
Eoeinaghiis oo O07 - 1.40 RA SS ap 180 + 180 un ——
Gacophes oor 0-01 mA a Ss Te | oot 3 0. gu ————
Ptah 108 163-23 5 Donn - Tous os Cage oo
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Pobdocyiose SLIGHT pee aad
Perens mis Buintin- 0.1 00-at age. — eee ee

Sorology at

dirzsra0 waste)
sua2erat wos rar Gost Uptanes)

Coccidioldes 1lgM Antibody; lmmunodiffusion Titer; POSITIVE -- AB PRESENT@ 1:16

6. Later that day, Complainant called the premises over 10 times, according to her narrative
and did not get a return call. She was able to speak with staff who advised that the dog would
be started on Fluconazole. A prescription was written for Fluconazole 825mg, quantity 100 with 6
refills - give one capsule orally every 12 hours. Staff member, Ms. Caulkins, assisted Complainant
in finding a: compounding pharmacy in her area — she located Potter's House. Complainant
asked if a regular pharmacy would carry the medication and was advised that she may want
to call around to find out; premises staff would call in the prescription if Complainant identified
a pharmacy of her choosing. The fluconazole strength needed was provided to Complainant.
The prescription was eventually called into Potter's House for Complainant.

7. On November 30, 2021, Complainant called with multiple questions regarding the dog's

Valley Fever diagnosis. Technical staff member, Steven Montana, spoke with Complainant per
Respondent's request. They discussed ensuring the dog was started on fluconazole to help keep

Page 3

22-73, JOHN MONTANA, DVM

it from spreading — it was unknown how long the dog would need to be on the medication and
the titer would need to be rechecked in two months to see if the dog was improving.
Complainant also advised that the dog's appetite had diminished; Mr. Montana stated that the
fluconazole should help improve the dog's appetite but if the dog did not improve Respondent
could prescribe an appetite-stimulant or recheck the dog. Complainant appeared satisfied with
the information Mr. Montana provided and was told to call if there were further concerns. She
indicated that she did not need to speak with Respondent: Complainant denies she no longer
needed to speak with Respondent.

8. According to Complainant, Mr. Montana did: not want her to go another day without
knowing the test results but could not answer questions she had about the dog's disease or
diminished appetite. In Respondent's submission to the complaint, there is a note that
Complainant wanted to speak to Respondent regarding the blood results.

?. On December 1, 2021, Complainant called Respondent's premises three times to speak with
Respondent and advise that the dog was not eating well. She asked if she could give the dog
Entyce; Respondent approved the refill request for the prescription Complainant put in through
Petco. Complainant was to administer 7mLs once daily.

10. Complainant stated that she called Respondent's premises approximately four times on
December 15th and 16". She left a message with concerns the dog may have pneumonia and
never received a call back.

11. On December 15, 2021, Dr. Wood at Legacy Veterinary Services reported the dog was
presented to her for a decline in health. Complainant explained the dog was-diagnosed with
Valley. Fever two weeks prior and was prescribed fluconazole 1620mg a day. Dr. Wood stated
she was advised by Complainant that the dog would only eat if he was hand fed, he was
coughing and.had discharge from his eyes and nose; she was unable to get an appointment
with Respondent.

12. Upon exam, the dog had.a weight = 150 pounds (weight from previous vet/no scale
available at Legacy Veterinary Services), temperature = 105.6 degrees, heart-rate = 120bpm,
and a respiration rate = 48rom. Dr: Wood noted the dog was QAR; she found crackles and °
wheezes in the lower quadrants of the lungs on both sides therefore the dog was diagnosed
with an infection in the lungs. Dr. Wood: prescribed the dog Amoxicillin/Clavulanate: and
recommended putting the dog in the bathroom while running hot water to build up steam to
help loosen mucous. Complainant was also instructed to use cool water to help decrease the
dog's temperature. The dog was administered 1 unit of ozonated saline prior to discharge.

13. On December 17, 2021, the dog was presented to Dr. Wood for a recheck due-to continuing -
to be febrile. Dr. Wood examined the dog; the dog had a weight = 150 pounds (no scale/using
same weight as previously) and a temperature = 103.6 degrees. She noted the dog still had
crackles and wheezing in the lower quadrants, discharge from the eyes, and was QAR. The dog
was administered 1 unit of ozonated saline SQ, lliter fluids (type unknown) SQ and was
discharged with Previcox 227mg - give 1.5 tablets once a day as needed for persistent fevers.

Page 4 °

22-73, JOHN MONTANA, DVM

Dr. Wood encouraged Complainant to entice the dog with different foods to get him to eat.
14. On December 20, 2021, the Amoxicillin/Clavulante was refilled by Dr. Wood.

15. On December 27, 2021, the dog was presented to Dr. Wood for a recheck exam. The dog
had been on antibiotics for approximately 10 days and’ was not consistently eating.
Complainant reported that the dog had lost weight but would eat on occasion. The dog was
no longer coughing and had not had a fever recently. Upon exam, the dog had a weight = 130
pounds (approximate weight?), a temperature = 100.1 degrees, a heart rate:= 120bpm, anda
respiration rate = 36rpm. The dog's lungs were clear and no discharge from the eyes and nose.
The dog was administered autohemotherapy with ozone and 3.5mL of vitamin B12 IM. Dr. Wood
was advised by her associate that marshmallow root and fennel seed made into a tea could
help with the dog’s appetite. Complainant wanted to try milk thistle which was approved by Dr.
Wood. Dr. Wood stated in her narrative that Complainant did not tell her that she had Entyce
from Respondent.

16. On December 29, 2021, Complainant reported the dog was still not eating consistently. She
had tried herbs, but the dog would not drink the tea. Complainant reported that she had
Entyce that she obtained from another veterinarian —she gave the dog 2.5mLs as it seemed to
help with the dog's appetite. Dr. Wood recommended rechecking the blood work as she was
concemed that the fluconazole could have affected the dog's liver.

17, When the dog was presented to Dr. Wood, Complainant reported that she had given.the
dog another 2.5mLs of Entyce; a total of 5mLs. Blood was collected for testing. After the results
were back, Dr: Wood called Complainant to report the abnormalities with respect tothe dog's
kidney values._Dr. Wood recommended discontinuing the fluconazole and Entyce and to bring
the dog in for IV fluid treatment the next day. Blood results:

Onderest Dec 29, 2021

Recetest Dec 29, 2021 ww 38 095.010 ]

‘Smatcar HESKA CLOUD MONO 06 0315 109344 |

Rewite Comprehensive Panei GRAN a 25-12010°34 i

Name Seas Beference-range

SUN 1106 - + 90-29.0 mgt) t ms 313 *

Creatinine 56 04-14 mpfel ’ MONO a7 %

BUN/Crex Ratio 198 Gaia ao %

Phosphons on eieginee ! ar an 310550% I

Calchsm 100 90-122 mpfal '

Totab Protein 5s SS-7.4 yd ' uty mi enn0f

‘Nbumin 2s 25-4096 1 koWa 30 w0e608 {

Globulin 20 203.6 9/0 | Rows 6s 120175%

peopcr ie bars 43 152 120180978: I

Gucose n 7-125 mgr

Chotesterol 28 120-310 mga 1 MCHC 7 320-385 gil 1

ALT(GPT) “6 O120uA ! uch uw 195-25.5 pg i

ap as 14000 t eC 5St SSEDINSY . 1

cor 7 O14uA . i} ar r) 20500 14

Gairubin o 0005

= , sa uv 102. sS105f !
J Rems Heska Hematrue Cec

‘Ondereg: Dee 29, 2021 05C Tine 46 se

presen sara WSC Tine 125 se

dimes + Asp. Time A bead

Mama faut Reference range ‘Asp Mode or

wee 126 60-170 10°34 t or

Page 5

22-73, JOHN MONTANA, DVM

18. On December 30, 2021, the dog was.presented to Dr. Wood for IV fluids. An lV catheter was
placed and the dog was administered 1 liter of IV fluids (type unknown). Later that day, the dog
returned for a blood draw and was administered. another Liter of IV fluids — this time ozone and
B12 were added. Recheck blood results:

Source: HESKA CLOUD

Notes
Name Besult Seferencorangs
BUN 106.6 9.0-29.0 mg/dl 1
Creatinine 42 0.4-1.4 mg/dl I
BUN/Crent Ratlo 25.4
Phosphorus 8.0 1.9-5.0 mg/dl i}
Calclum 10.1 9.0-12.2 mg/d t
Total Protein 53 5.5-7.6 g/dl !
Albumin 24 2.5-4.0 g/dl i]
Globutin 29 2.0-3.6 g/d? 1
Alb/Glob Ratio oe
Glucose 79 75-125 mg/di !
Cholesterol 226 120-310 mg/dl t
ALT(GPD 54 0-120 UA 1
aLp 226 0-140 UA 1
Gor 10 O-14UA i}
Totat Bilirubin <01 0.0-0.5 mg/dl

19. Dr. Wood told Complainant that the blood work showed only minimally decreased kidney
values.and recommended taking the dog to an emergency facility for IV fluids and additional
diagnostics. Dr. Wood called VETMED and spoke with an emergency veterinarian; she gave the
dog's history and current blood values. The emergency veterinarian did not feel the dog had a
good prognosis and costs to treat the dog could be extensive. Dr. Wood passed this information
to the Complainant and the dog was taken to VETMED.

20. Later that day, the dog was taken to: VETMED for evaluation. Dr. Goff examined the dog;
weight = 135 pounds, temperature = 101.8 degrees, pulse = 100bpm, and panting respirations;
approximately 5% dehydrated. Blood, blood pressure, and urine testing showed:
a. BP - 150mmHg;
b. 10p iStat8- Na 148, K 3.5, Cl 124, BUN 81, Creat 4.5, BG 79, iCa2+ 1.33, HCT 40, PV/TS
42%/7.1 (serum clear); and
c. USG -1.015.

21. Dr. Goff discussed causes for acute kidney insult, including potentially from recent NSAID
dose. Secondary to fluconazole considered unlikely. Hospitalization was recommended for
symptomatic treatment and repeat labs, as well as further workup to try and identify:specific
cause.or other concurrent disease: that could cause hyporexia and weight loss:seen over the
past morith. Prognosis was guarded. Complainant approved hospitalization and some.
diagnostics recommended. The dog was hospitalized for IV fluids, supportive care and
diagnostics.

22. Anulirasound was performed and the primary differential was acute renal insult, possibly
secondary to interstitial. nephritis, toxic nephropathy, or pyelonephritis.-An acute on.chronic
process was.also considered. A congenital developmental abnormality or infiltrative neoplasia
was considered less likely, but not entirely excluded.

Page 6

22-73, JOHN MONTANA, DVM

23. Over the next couple of days, the dog's BUN was improving but creatinine remained stable
around 4.0 —the acute kidney injury likely became chronic. Prognosis remained guarded. The
dog remained hospitalized and treatment regime was adjusted as needed.

24. On January 3, 2022, due to the dog's condition with no significant improvement and the
very guarded prognosis, Complainant elected to humanely euthanize the dog.

COMMITTEE DISCUSSION:

The Committee discussed that they had concerns with the case. There was conflicting
information surrounding the offering and dispensing of Doxycycline. There were also concerns
about the lack of communication from Respondent. There was a note in the file that
Complainant requested to speak to Respondent directly; both parties agree there was no
further communication after the November 22" exam. Additionally, the Valley Fever titer was
relayed to Complainant through a staff member who could not answer any follow up
questions. Complainant called again with further questions and Respondent did not feel it
was necessary to speak to Complainant directly.

The Committee commented that they understand premises have a large number of calls

however, at some point the veterinarian has to recognize their responsibility and speak to a
pet owner. Staff is not always qualified to answer medical questions that pet owners have.

The Committee also had concerns with medical record omissions that are required to be
documented.

COMMITTEE'S PROPOSED CONCLUSIONS of LAW:
The Committee concluded that possible violations of the Veterinary Practice Act occurred.
COMMITTEE'S RECOMMENDED DISPOSITION:
Motion: It was moved and seconded the Board:
ARS § 32-2232 (12) as it relates to AAC -R3-11-501 (1) failure to show respect to the pet
owner for never speaking to the owner regarding the Valley Fever results/titer or

regarding the owner's concerns for the dog's condition;

ARS § 32-2232 (21) as it relates to AAC R3-11-502 (L) (4) failure to document the dog's
heart rate and respiratory rate in the medical record on November 22, 2021; and

ARS § 32-2232 (21) as it relates to AAC R3-11-502 (L) (5) failure to document the dog’s
tentative or definitive diagnosis in the medical record on November 22, 2021.

Vote: The motion was approved with a vote of 5 to 0.

Page 7

22-73, JOHN MONTANA, DVM

The information contained in this report was obtained from the case file, which includes the
complaint, the respondent's response, any consulting veterinarian or witness input, and any
other sources used to gather information for the investigation.

re

Tracy A. Riendeau, CVT
Investigative Division

Page 8

np

w

BEFORE THE ARIZONA VETERINARY MEDICAL EXAMINING BOARD

IN THE MATTER OF: CASE NOo.: 22-73

JOHN MONTANA, DVM CONSENT AGREEMENT
FINDINGS OF FACT

HOLDER OF LICENSE No. 1870 CONCLUSIONS OF LAW

FOR THE PRACTICE OF VETERINARY AND ORDER

MEDICINE IN THE STATE OF ARIZONA,

RESPONDENT.

ee Ne ee es ee 8

In the interest of a prompt and judicious settlement of the above captioned
matier before the Arizona State Veterinary Medical Examining Board (“Board"}
and consistent with the public interest, statutory requirements and
responsibilities of the Board, and pursuant to A.R.S. §32-2201 ef. seq. and A.R.S.
§ 41-1092.07 (F)(5), the undersigned party, John Montana, DVM
("Respondent"), holder of license No. 1870 for the practice: of veterinary
medicine in Arizona and the Board enter into this Consent Agreement, Findings
of Facf, Conclusion of Law and Order ("Consent Agreement") as final

disposition of this matter.

CONSENT AGREEMENT
Respondent understands and agrees that:
1. The Board has jurisdiction over Respondent and the subject matter
pursuant to A.R.S. §32-2201, ef. seq.
2. Respondent has the right to consult with an attorney prior to entering into

this Consent Agreement. Respondent has a right to a public hearing

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concerning this case. He furiher acknowledges that at such hearing he could
present evidence and cross-examine witnesses. Respondent irrevocably waives
his right to such a hearing.

3. Respondent irrevocably waives any right to rehearing or review or to any
judicial review or any other appeal of these matters.

4. The Consent Agreement, once approved by the Board and signed by the
Respondent, shall constitute a public record, which may be disseminated as a
formal action of the Board. Sufficient evidence exists: for the Board: to make the
Findings of Fact and Conclusions of Law set forth in the Consent Agreement.

5. Respondent acknowledges and understands that this Consent
Agreement will not become effective until it-is signed:by the Board's Executive
Director. Respondent: acknowledges: and agrees. that upon signing and
returning this. Consent Agreement to the Board's Executive Director,
Respondent may not revoke. his ‘acceptance of the Consent Agreement or
make any modifications to the document, regardless of whether the Consent

Agreement has been issued by the Executive Director.

6. If any part of the Consent Agreement is later declared. void or otherwise.

unenforceable, the remainder of the: Order:in its entirety shall remain in force
and effect.

7. Respondent acknowledges that. any violation of this Consent Agreement
constitutes. unprofessional. conduct pursuant to A.R.S. § 32-2232 and may result
in disciplinary action pursuant to A.R.S. § 32-2234.

8. This. Consent Agreement and Order is effective on the date signed by the

|) Board.

22-73, John Montana. DVM

DATED this “ZS __ day of ( Daooh 2022.

John Montana, DVM

FINDINGS OF FACT
1. The Board is the duly. constituted authority for the regulation and contro! of
the practice of veterinary medicine in the State of Arizona.
2. Respondent holds license No. 1870 for the practice of veterinary medicine
in the State of Arizona.
3. On November 22, 2021, “Jackson,” an approximately. 1-year-old male

English Mastiff:was presented ‘to: Respondent. due to lethargy and: anorexia.

|| Respondent stated in:his narrative that Complainant was: concerned the dog

was poisoned. due tothe loss:of ‘a previous. pet in the past. Complainant denies

‘lj that she was concerned the dog: was poisoned. The dog had a weight = 153.4 |
pounds.and a temperature = 104 degrees; no heart rate or respiration rate was |

noted: Respondent :documented heart, lungs. good; lungs -clear. He}.

recommended blood work, Doxycycline, and an injection: of dexamethasone.
Complainant approved the blood work. and dexamethasone but: declined
antibiotics at that time. The dog was administered 15mg dexamethasone IM
and. was discharged.:Complainant and her partner, Mr. Tolmachoff, denied
Respondent offered antibiotics.

4. On November 24, 2021, Complainant stated:she called to get test results
but did not:get a call back. According :to Respondent's ‘medical : records,

Complainant: called to report the dog was .coughing and had nasal

22-73, John Montana. DVM

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congestion. Complainant denies she reported the dog was coughing. Partial
lab results were back and revealed mild anemia, neutrophilia, and more
substantial monocytosis. Respondent dispensed Doxycycline 100mg, 30 tablets;

give 3 tablets orally every 12 hours, Complainant denies Respondent dispensed

antibiotics.

5. After the Thanksgiving holiday, Respondent’s premises was closed.

6. On November 29, 2021, Complainant stated she called to get the Valley
Fever results. She was advised by staff that the test was positive with a titer 1:16.
Complainant was told Respondent would call her to discuss. Respondent did
not return Complainant's call.

7. Later that day, Complainant called the premises over 10 times, according
to her narrative, and did not get a return call. She was able to speak with staff
who advised that the dog would be started on Fluconazole. A prescription was
written for Fluconazole 825mg, quantity 100 with 6 refills — give one capsule
orally every 12 hours. Staff member, Ms, Caulkins,. assisted Complainant in
finding a compounding pharmacy in her area — she located Potter's House.
Complainant asked if a regular pharmacy would carry the medication and was
advised that she may want to call around to find out; premises staff would call
in the prescription if Complainant identified a pharmacy of her choosing. The
fluconazole strength needed was provided to Complainant. The prescription
was eventually called into Potter's House for Complainant.

8. On November 30, 2021, Complainant called with multiple questions
regarding the dog's Valley Fever diagnosis. Technical staff member, Steven
Montana, spoke with Complainant per Respondent's request. They discussed

ensuring the dog was started on Fluconazole to help keep the infection from

22-73, Jonn Montana. DVM

spreading — it was unknown how long the dog would need to be on the
medication - the titer would need to be rechecked in two months to see if the
dog was improving. Complainant also advised that the dog's appetite had
diminished; Mr. Montana stated that the Fluconazole should help improve the
dog's appetite, but if the dog did not improve, Respondent could prescribe an
appetite stimulant or recheck the dog. Complainant appeared satisfied with
the information Mr. Montana provided and was told to call if there were further
concerms. She indicated that she did not need to speak with Respondent.
Complainant denies she no longer needed to speak with Respondent.

9. According to Complainant, Mr. Montana did not want her to go another
day without knowing the test results but could not answer questions she had
about the dog's disease or diminished appetite. In Respondent's submission to
the complaint, there is a note that Complainant wanted to speak to
Respondeni regarding the blood results.

10. On December 1, 2021, Complainant called Respondent's premises three
times to speak with Respondent and advise that the dog was not eating well.
She asked if she could give the dog Entyce; Respondent ‘approved the refill
request for the prescription Complainant put in through Petco. Complainant
was to administer 7mLs once dally.

11. Complainant stated that she called Respondent's premises
approximately four-times on December 15th and 1éth. She left a message with
concerns the dog may have pneumonia and never received a call back.

12. On December 15, 2021, Dr. Wood at Legacy Veterinary Services reported
the dog was presented to her for a decline in health. Complainant explained

the dog was diagnosed with Valley Fever two weeks prior and was prescribed

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Fluconazole 1620mg a day. Dr. Wood stated she was advised by Complainant
that the dog would only eat if he was hand fed, he was coughing and had
discharge from his eyes and nose; she was unable to get an appointment with
Respondent.

13. Upon exam, the dog had a weight = 150 pounds (weight from previous
vet/no scale available at Legacy Veterinary Services), temperature = 105.6
degrees, heart rate = 120bpm, and a respiration rate = 48rpm. Dr. Wood noted
the dog was QAR; she found crackles and wheezes in the lower quadrants of
the lungs on both sides; therefore, the dog was diagnosed with an infection in
the lungs. Dr. Wood prescribed the dog Amoxicillin/Clavulanate and
recommended putting the dog in the bathroom while running hot water to
build up steam to help loosen mucous. Compiainant was also instructed to use
cool water to help decrease the dog's temperature. The dog was administered
1 unit of ozonated saline prior to discharge.

14. On December 17, 2021, the dog was presented to Dr. Wood for a
recheck due to continuing to be febrile. Dr. Wood examined the dog; the dog
had a weight = 150 pounds {no scale/using same weight as previously) and.a
temperature = 103.6 degrees. She noted the dog still had crackles and
wheezing in the lower quadrants, discharge from the eyes, and was QAR. The
dog was administered 1 unit of ozonated saline SQ, lliter fluids SQ and was
discharged with Previcox 227mg — give 1.5 tablets once a day as needed for
persistent fevers. Dr. Wood encouraged Complainant to entice the dog with
different foods fo get him to eat. |

| 15. On December 20, 2021, the Amoxicillin/Clavulante was refilled by Dr.
Wood.

22-73, Jonn Montana. DVM

16. On December 27, 2021, the dog was presented to Dr. Wood for a
recheck exam. The dog had been on antibiotics for approximately 10 days and
was not consistently eating. Complainant reported that the dog had lost
weight but would eat on occasion. The dog was no longer coughing and had
not had: a fever recently. Upon exam, the dog had a weight = 130 pounds
(approximate weight?), a temperature = 100.1 degrees, a heart rate = 120bpm,
and a respiration rate = 36rom. The dog's lungs were clear and no discharge
from the eyes and nose. The dog was administered autohemotherapy with
ozone and 3.5mL of vitamin B12 IM. Dr. Wood was advised by her associate
that marshmallow. root and fennel seed made into :a tea.could help with the
dog's appetite. Complainant wanted to try milk thistle which was approved by
Dr. Wood.'Dr. Wocd ‘stated. in her:narrative that Complainant did not tell her
that she had Entyce from:Respondent. |

17..On December 29, 2021, Complainant:reported the dog was still not

‘eating consistently. She had tried herbs, but the dog would not drink the tea.
||Compiainant reported that she had Entyce that she obtained from another
veterinarian —:she gave.the dog 2.5mLs.as it seemed to help with the. dog's |.

appetite. Dr. Wood recommended rechecking the blood work as she was |

concerned that the fluconazole could have. affected.the dog's liver.

7 18. When the dog was presented to Dr. Wood, Complainant reported ‘that’
she had ‘given the dog another 2.5mLs of Entyce; a total of 5mLs. Blood was.
collected for testing. After the results were:back, Dr. Wood called Compiainant

to report the abnormalities with respect to the dog's kidney values. .Dr.. Wood:

recommended discontinuing the fluconazole and Entyce and to bring the dog

in for IV fluid treatment the next day.

22-73, John Montana. DVM

19. On December 30, 2021, the dog was presented to Dr. Wood for IV fluids.
An IV catheter was placed and the dog was administered 1 liter of IV fluids
Later that day, the dog returned for:a blood draw and was administered
another Liter of IV fluids — this time ozone and B12 were added.

20. Dr. Wood told Complainant that the blood work showed only minimally
decreased kidney values and recommended taking the dog to an emergency
facility for IV fluids and additional diagnostics. Dr. Wood called VETMED and
spoke with an emergency veterinarian; she gave the dog's history and current
blood values. The emergency veterinarian did not feel the dog had a good
prognosis and costs to treat the dog could be extensive. Dr. Wood passed this
information to the Complainant and the dog was taken to VETMED.

21. Later that day, the dog -was.taken fo VETMED for evaluation. Dr. Goff

j/examined the dog and noted the dog was approximately 5% dehydrated.
‘|| Diagnostics were performed and ‘Dr. Goff. discussed causes. for acute kidney

jJinsult, including. potentially from recent NSAID dose. Secondary to Fluconazole

considered unlikely. Hospitalization was recommended :for symptomatic
treatment and repeat labs,- as well as further workup to try and identify specific

cause or other concurrent disease that could cause hyporexia and weight loss

seen. over the past month. Prognosis was guarded. Complainant approved

hospitalization and some diagnostics recommended. The dog was hospitalized
for IV. fluids, supportive care and diagnostics.
22..An ultrasound was performed and the primary differential was acute

renal insult, possibly secondary to interstitial nephritis, toxic nephropathy, or

1} pyelonephritis. An acute on chronic process was also considered. A congenital

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developmental abnormality or infiltrative neoplasia was considered less likely,
but not entirely excluded.

23. Over the next couple of days, the dog's BUN was improving but
creatinine remained stable around 4.0 - the acute kidney injury likely became
chronic. Prognosis remained guarded. The dog remained hospitalized and
treatment regime was adjusted as needed.

24. On January 3, 2022, due to the dog's condition with no significant
improvement and the very guarded prognosis, Complainant elected to
humanely euthanize the dog.

25. The Board concluded that Respondent's conduct fell below the
standard of care by not speaking with Compiainant at any point after the initial
examination. Respondent did not discuss the Valley Fever titer or Complainant's
concerns for the dog's condition after she attempted. fo, and requested to,
speak. to him multiple times.

CONCLUSIONS OF LAW

26. The Findings of Fact constitutes a violation of A.R.S. § 32-2232 (12) as it
relates to A.A.C. R3-11-501 (1) failure to show respect to the pet owner for
never speaking to the owner regarding the Valley Fever results/titer or
regarding the owner's concerns for the dog's condition.

27. The Findings of Fact constitutes a violation of A.R.S. § 32-2232 (21) as it
relafes to A.A.C. R3-11-502 (L) (4) failure to document the dog’s heart rate and
respiratory rate in the medical record on November 22, 2021.

ORDER
Based upon the foregoing Findings of Fact and Conclusions of Law it is

ORDERED that Respondent's License, No. 1870 be placed on PROBATION for a

22-73, John Montana. DVM

period of one (1) year, subject to the following terms and conditions that shall
be completed within the Probationary period. These requirements include six
(6) total hours of Board-approved continuing education (CE) detailed below:

1. IT IS ORDERED THAT Respondent shall provide written proof satisfactory
to the Board that he has completed three (3) hours of continuing education in
the topic of client communication. Hours earned in compliance are in addition
to the continuing education requirements of A.A.C. R3-11-401 (A).

2. IT JS ORDERED THAT Respondent shall provide written proof satisfactory
to the Board that he has completed three (3) hours of continuing education in
medical record keeping. Hours earned in compliance are in addition to the
continuing education requirements of A.A.C. R3-11-401 (A).

3. All continuing education to be completed for this Consent Agreement

as noted in paragraphs 1] and 2 shall be pre-approved by the Board. Within sixty |

(60) days of the effective date of the Consent Agreement, Respondent shall
submit to the Board for its approval a written ouiline of how he plans to satisfy
the CE requirements. The outline shall include CE course details including,
name, provider, date(s), hours of CE to be earned, and a brief course summary.

4, Prior to the end of the Probationary period, Respondent shall submit to
the Board certificates of completion of the CE outlined in the CE plan that has
been approved by the Board,

5. Respondent shall obey all federal, state and local laws/rules governing
the practice of veterinary medicine in this state.

6. Respondent shall bear all costs of complying with this Consent

Agreement.

22-73, John Montana. DVM

7. This Consent Agreement is conclusive evidence of the matters
described and may be considered by the Board in determining an appropriate
sanction in the event a subsequent violation occurs. in the event Respondent
violates any term of this Consent Agreement, the Board may, after opportunity
for Informal Interview or Formal Hearing, take any other appropriate disciplinary
action authorized by law, including suspension or revocation of Respondent's

license.

ISSUED THIS (of DAY OF Segtienkse, 2022.
FOR THE BOARD:
ARIZONA STATE VETERINARY MEDICAL EXAMINING BOARD

Jessica Creager, Chairperson

By
Victoria Whitmore, Executive Director

Original ot the foregoing filed
This__6 day of 2022 with:

Arizona State Veterinary Medical Examining Board
1740 W. Adams St, Ste. 4600
Phoenix, Arizona 85007

Copy of the foregoing mailed by Certified, return receipt mail
This_ 6 day of _Sflimbe-, 2022 to:
John Montana, DVM

Address on file
Respondent

Copy of the foregoing sent by regular mail

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this 6" day of Seetermde~ _, 2027 to:

David Stoll, Esq.

Beaugureay, Hancock, Stoll and Schwartz, PC
302 E. Coronado Rd

Phoenix, Arizona 85004

By: A Mdeme

Board Staff

22-73, Jonn Montana. DVM