Supplementary memorandum submitted by
the Royal College of Veterinary Surgeons (Vet 11a)
RCVS RESPONSES TO
QUESTIONS FROM
THE EFRA SELECT
COMMITTEE
How many complaints did the RCVS receive last
year?
709 in the period 1 April 2006 to 31 March 2007.
The annual average over the last eight years has been about 700.
The major subject of the complaints was alleged inadequate
care (272). Communications between the practice and the client
were the next most important subject of complaint (150). 81 complaints
concerned fees.
What is that number as a percentage of the total
number of consultations?
We don't know the total number of veterinary
consultations. We estimate that, of some 22,000 veterinary surgeons
on the register on 31 March 2007, between 12,000 and 13,000 were
in general practice, not necessarily full time. The number of
consultations in a day will vary greatly according to the type
of practice, but in a typical small animal practice a veterinary
surgeon might see perhaps 20 cases a day. On that basis the number
of consultations each year will be in the tens of millions.
How many of those complaints were considered by
the Preliminary Investigation Committee (PIC) and passed on to
the Disciplinary Committee (DC)?
In 2006-07 731 complaints were dealt with. 11
of them (1.5%) were referred to the Disciplinary Committee.
What happened to the rest? The sifting process involves
three stages:
— assessment by a legally qualified
member of staff and a veterinary surgeon to identify complaints
where there is a potential case against the veterinary surgeon.
At this stage any cases which do not fall within the RCVS jurisdiction
are weeded out (please see the notes below on the nature of the
jurisdiction);
— case examination by two veterinary
surgeons to identify complaints where there is an arguable case
against the veterinary surgeon;
— consideration by PIC to identify
complaints where there is a realistic prospect of proving a case
against the veterinary surgeon.
Of the 731 complaints dealt with in 2006-07:
— 33 (5%) were closed because the complainant
chose not to pursue the matter;
— 301 (41%) were closed following assessment
because there was no complaint falling within the College's jurisdiction;
— 154 (21%) were closed after case
examination because there was no arguable case to be answered;
— 232 (31.5%) were closed by the PI
Committee because there was no realistic prospect of proving a
case against the veterinary surgeon;
— 11 (1.5%) were referred to the Disciplinary
Committee.
How many of the complaints considered by the DC
resulted in disciplinary action?
DC held 13 disciplinary inquiries in 2007:
— 6 veterinary surgeons were removed
or suspended from the register;
— 1 veterinary surgeon was reprimanded;
— 1 health type case was postponed
subject to conditions;
— 2 veterinary surgeons were found
guilty of disgraceful conduct, which was considered a sufficient
sanction and no further action was taken;
— 3 cases were dismissed.
Could you provide details of the type of complaints
considered by the DC last year?
Please see annex A.
Could you also provide details of the type of
complaints that come before the PIC but are rejected?
Examples are attached in annex B.
What is the jurisdiction of the Disciplinary Committee?
The Committee may direct the removal or suspension
of a veterinary surgeon from the register if he or she has
(a) been convicted of an offence which in
the Committee's opinion renders him or her unfit to practise veterinary
surgery or
(b) has been guilty of disgraceful conduct
in any professional respect.
In deciding what amounts to "disgraceful
conduct in any professional respect" the Committee has regard
to decisions by the courts, which have had to interpret similar
words in the legislation governing other professional regulators.
The courts refer to "serious professional misconduct".
A veterinary surgeon may be guilty of such misconduct as a result
of unethical behaviour (for example, false certification or misuse
of controlled drugs). Clinical malpractice (for example, serial
incompetence) may also amount to serious professional misconduct.
A simple mistake would not normally amount to serious professional
misconduct, but it may provide the basis for an action for a civil
action for damages.
To illustrate the point, a veterinary surgeon
who operates on a dog and leaves a swab inside may be liable to
be sued for negligence. If he or she lies about having made the
mistake, this may be considered serious professional misconduct.
In some cases there is an overlap between serious
professional misconduct and negligence. More serious negligence
may amount to serious professional misconduct. For example, if
a veterinary surgeon is reckless in the care of an animal or makes
the same error repeatedly, this could amount to both negligence
and serious professional misconduct.
What difference would new legislation make to
the way complaints are dealt with?
The legislation which RCVS proposes would make
a difference in two ways.
First, we propose that the jurisdiction of the
new Conduct and Competence Committee should, as the name implies,
embrace fitness to practise in the broadest sense—not just
behaviour. The Committee should be able to consider issues of
health and professional performance. "Fitness to practise"
is currently only relevant in the case where a veterinary surgeon
has a criminal conviction, and that is clearly a different sense
of the expression.
The change in the jurisdiction of the tribunal
would affect the complaints that could properly be referred to
it. At the moment PI Committee has to consider whether the facts
support the allegation of disgraceful professional conduct, or
whether a veterinary surgeon has a criminal offence which calls
into question his or her fitness to practise.
Secondly, we think the legislation should give
power to introduce mandatory standards for the delivery of veterinary
services. The present legislation only regulates individual practitioners,
and does not offer remedies to complainants who are concerned
about the way a practice has treated them. Currently complaints
about bad communications, inadequate staffing, poor standards
of hygiene or equipment and the like can only be dealt with if
an individual veterinary surgeon can be shown to have been guilty
of disgraceful conduct. Very often such deficiencies will be the
result of management failings, and the practice may not be controlled
by veterinary surgeons. We want all practices to be publicly accredited
against statutory standards, with compliance monitored through
inspections, so that we can spot problems at an early stage rather
than waiting for complaints to come in.
RCVS
February 2008
Annex A
DECISIONS BY RCVS DISCIPLINARY COMMITTEE
IN 2007
| Nature of the complaint
| Outcome |
| Dishonesty—false certification to allow a horse to compete under Jockey Club rules
| Directed to be removed from the register; reduced to 6 month suspension by the Privy Council
|
| Theft of controlled drugs | Removed from the register
|
| Hitting his horse once while riding in a competition
| Facts proved but not found to be disgraceful conduct
|
| Prescription and supply of medicine to a racing greyhound contrary to the rules of racing
| Disgraceful conduct, no further action |
| Dishonesty on pre-purchase certificate for a horse—giving his opinion that the animal was fit for purpose when not true
| Removed from the register |
| Transport of a horse when it was alleged the animal was unfit to travel
| Case dismissed, DC decided the veterinary surgeon made a reasonable decision
|
| Reckless, false certification to insurers for the benefit of the animal owner
| Suspended for 2 months |
| Failure to make a home visit to an animal in need of veterinary treatment
| Removed from the register |
| Informed consent to treatment options and fees of £4,667
| Case dismissed after evidence of consent provided
|
| Prescription and supply of medicines to partner
| Reprimand |
| Conviction—causing death by careless driving while under influence of alcohol
| Judgment postponed 2 years with conditions
|
| Reckless false certification | Directed to be removed from the register—appeal pending
|
| Prescription and supply of medicine to a racing greyhound contrary to the rules of racing
| Disgraceful conduct, no further action |
Annex B
SAMPLE CASES CONCLUDED BY PRELIMINARY INVESTIGATION COMMITTEE
CASE 1
During 2004, the complainant's four year old bitch was spayed.
In January 2007 the bitch developed a lump (later diagnosed as
a subcutaneous cyst) on her right-hand side, which burst twice.
After several unsuccessful procedures to treat the subcutaneous
cyst, the first practice referred the bitch. The referral practice
carried out exploratory abdominal surgery which confirmed there
was a mass behind the bitch's right kidney. The mass and right
kidney was removed together. After the procedure the mass was
opened and within the centre was a surgical swab, which had been
acting as a foreign body causing irritation to local tissues.
The complainant alleged that the veterinary surgeon had been
negligent to leave the swab. On the complaints form, the complainant
expressed concern that although the veterinary practice accepted
the error, it did not accept responsibility, because the veterinary
surgeon who had carried out the spay procedure had since left
its employment.
The complaint was closed on the basis that the complainant's
allegation was an allegation of professional negligence, against
the practice and veterinary surgeon, which even if proved, could
not amount to serious professional misconduct against the veterinary
surgeon.
CASE 2
A 12 year old cross breed bitch suffering with constipation
was admitted for radiographs to be taken of the pelvic area, for
the purpose of eliminating a tumour as a cause for her constipation.
The complainant alleged that due to the bitch's age, she was informed
that it was safer to carry out the radiographs under sedation
rather than general anaesthetic. The bitch was sedated and the
radiographs obtained but no tumour was diagnosed.
Later another practice diagnosed the bitch as having a tumour.
It was questioned whether a radiograph taken under general anaesthetic
might have been of better quality. She said she was not told by
the first practice that radiographs taken using general anaesthetic
were likely to be of better diagnostic quality and detail than
those taken under sedation.
The complainant submitted a complaint to the College alleging
missed-diagnosis. The complaint was closed on the basis that the
missed-diagnosis could not amount to serious professional misconduct.
It was accepted that good communication is essential to good veterinary
practice but the communication issue identified could not, even
if proved, amount to serious professional misconduct.
CASE 3
A two year old male cat was taken to a veterinary practice
with a high temperature. A fee of £150 was given, and the
cat was hospitalized overnight, fluids administered and various
tests undertaken. The next day the complainant says she was told
by the veterinary surgeon that he suspected the cat was suffering
with a virus, but to identify the virus would involve high costs.
As the cat's temperature had reduced and all its vital organs
appeared to be functioning, it was discharged with a five day
course of antibiotics. The final bill was £225.
The cat improved over a period of 10 days but ultimately
lost its appetite again and the complainant took it to another
veterinary practice where it was diagnosed with Feline Aids. The
complainant says that she was advised the infection would not
improve and elected for euthanasia of the cat.
The complainant submitted a complaint to the College because
she was dissatisfied that she paid £225 to the first practice
"for nothing" because the illness was terminal.
The complaint was closed on the basis that there was no issue
of conduct.
CASE 4
A cat was anaesthetised without the consent of the client.
The client had signed a consent form specifically requesting that
no anaesthetic be given. The veterinary surgeon accepted that
there had been a breakdown in communication within the practice
and that the information concerning the client's wishes had not
been passed to him. Taking into account the full and frank response
from the practice the case was closed with advice rather than
referral to DC.
CASE 5
The complaint concerns a veterinary practice's alleged failure:
to seek the client's permission for an alternative veterinary
surgeon to undertake surgery in the place of the agreed clinician;
to inform the client that another veterinary surgeon had undertaken
the surgery; and to provide adequate care to the bitch.
On 18 March 2005, Mr C, the client took his eight-month old
bitch to one of the practice's branch surgeries for a consultation
prior to the bitch's routine hysterectomy operation. During the
consultation Mrs A, the veterinary surgeon, said she used a technique
of internal, not external, suturing when completing a hysterectomy
operation and she was asked and agreed to carry out the surgical
procedure. The receptionist booked an appointment for the bitch's
hysterectomy to be carried out at a different branch, because
Mrs A preferred the facilities there.
On 23 March the Mr C arrived at the other branch surgery
for the procedure to be carried out—he completed the consent
form and the fee estimate was explained by a veterinary nurse,
following which the bitch was examined by Mr B, another veterinary
surgeon (not the requested clinician) who admitted the bitch for
surgery and, according to Mr C, said that Mrs A was on her way.
Mrs A was at another branch, running late and she liaised
with Mr B through the receptionists/nurses at the respective branches.
Mrs A said she explained to her receptionist that Mr C wanted
her to carry out the procedure and that Mr B should seek Mr C's
permission to proceed with the hysterectomy. Mr B said he had
been informed that he could perform the procedure. In addition,
he said there were no notes on the computer indicating Mr C's
preference and at no point that morning did Mr C request a specific
veterinary surgeon.
Mr C called the following day at 4pm to collect his bitch,
but was asked to come back. Later, the bitch was discharged by
the branch practice's head nurse, with a dressing covering the
wound and a collar. The practice said the bitch had recovered
well, but Mr C said the bitch was unable to walk when discharged.
Later that evening at about 6.30 Mr C noticed that the dressing
was blood stained and telephoned the practice's out-of-hours emergency
service. Mr C was given Mr B's mobile number and called him and
they agreed to meet at one of the branch surgeries. During the
telephone conversation, Mr C said that Mr B told him this did
not usually happen with Mrs A's work, a comment which Mr B denied.
Mr B attended to the bitch at the branch surgery as agreed and
observed that the bitch was distressed by the collar; he suggested
that it could be removed while the bitch was under supervision.
On 26 March, the Mr C returned the bitch to the practice.
There was a build-up of fluid at the site of the wound and antibiotics
were prescribed. Later that day Mr C left the bitch alone, during
which time the wound opened. Mr C telephoned the out-of-hours
emergency service for a different veterinary practice, where the
bitch was admitted as an in-patient for two days.
On 6 April, Mr C saw Mrs A for a post-op check up and Mrs
A informed him that she had not carried out the hysterectomy.
In the PI Committee's view Mr C was understandably upset by this
news; Mr C considered that as the procedure was elective it could
have been postponed until Mrs A was available.
On the first issue, the practice accepted that Mr A's wishes
had not been met and apologised for the breakdown in communication.
The PI Committee acknowledged this and commented that if the anticipated
veterinary surgeon is not available for a routine operating list,
it is not uncommon for other veterinary surgeons in a practice
to carry out the procedures.
On the second issue, the PI Committee noted the disputed
evidence and considered that an indication of serious professional
misconduct might exist, but only if Mr B had deliberately misled
Mr C. The PI Committee decided there was insufficient evidence
to support such an allegation against Mr B.
On the third issue, the PI Committee indicated that the different
methods of suturing would not have affected the post operative
complications, which were unfortunate but not an issue of conduct.
In the circumstances, the Committee decided that the complaint
should be closed with advice to Mr B that when there is an agreement
of this nature with a client, the client should give informed
consent to any change.
CASE 6
A 10-year old male Cocker Spaniel was admitted for a dental
procedure. The complainant, who was the daughter of the owners,
considered that an additional extraction was carried without the
consent of her parents, the owners of the dog, and that dog's
hearing had been affected following the procedures.
On 16 November 2006, Vet "A" examined the Cocker
Spaniel. The owners said the dog experienced pain on the right
side of its mouth when eating. Vet "A" diagnosed an
ulcer above the upper right last molar and noted on the clinical
record " . . . very painful and reluctant to open mouth and
allow cleaning, needs removal tci tomorrow, clip claws".
The complainant said the owners understood that only one molar
needed to be extracted and the risks of the procedure were not
discussed with the owners.
On 17 November 2006, the Cocker Spaniel was admitted for
the procedures to be carried out. A consent form was completed
and signed, which included "GA +Dental including extractions
+ check lump left side + clip claws (one grown into pad) . . .
. . . The attending veterinary surgeon or veterinary nurse has
discussed the risks with me."
The procedures were carried out by Vet "B" (the
Respondent veterinary surgeon), who having carried out the procedures,
noted on the clinical notes, "extract both upper caudal molars
where gum is receding and kissing ulcers developing. Polish remaining
teeth. Cauterise cyst left lateral thorax. Re-exam Monday".
On 20 November 2006 the owners returned to the practice for
the dog's post-operative check-up. The owners queried the extraction
of the second molar. In the written response to the complaint,
Vet "B" indicated that without the second extraction
the problem would have developed on the left side within a short
period of time and the decision to extract the additional tooth
was taken to avoid a further general anaesthetic and further cost
to the owners.
The owners told Vet "B" that they suspected the
dog had suffered hearing loss since his operation. Vet "B"
suggested there may have been some stretching of soft tissues,
including nerves, in order to gain adequate access to the dog's
teeth and if this contributed to the hearing loss it would be
temporary. Vet "B" said the owners seemed to accept
the explanation without further question.
On 24 November 2006, the complainant telephoned Vet "B"
querying the dental procedures and hearing loss.
During investigation of the complaint, the complainant said
that prior to the dental procedures; the dog had had "selective
hearing, rather like a child or an adult when they choose to hear
what they hear."
PI Committee noted that the complainant had not accompanied
her parents to the veterinary surgery at any time and that her
complaint was based solely on her parents' recollection and her
telephone conversation with Vet "B". The Committee commented
about the difficulty of relying on hearsay or "second-hand"
information.
The Committee considered there was no evidence to suggest
a lack of informed consent, noting the consent form was signed
and dated. The PI Committee suggested that if the practice had
provided the owners with a copy of the consent form prior to the
procedures, any misunderstanding about the procedures to be carried
out would have been less likely.
The PI Committee expressed doubt that the dog's reduced hearing
could have been as a result of the dental procedures and in the
absence of more detailed clinical information could not comment
further. It was noted that Vet "B" had explained the
possible causes of the dog's deafness and had expressed "sympathy"
for the dog's condition.
The Committee decided there was no indication of serious
professional misconduct against Vet "B"—nothing
that could question fitness to practise—and closed the complaint.
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