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Protocol ‘could plunge vets deeper into problems’

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01 November 2010, at 12:00am

Dr SHAMS MIR summarises the Vets4BVU response to the Royal College’s draft health protocol

THE draft “Health Protocol”, according to the RCVS, “aims to protect animals and the interests of the public by helping veterinary surgeons whose fitness to practise may be impaired because of adverse health” by dealing with the “veterinary surgeons suffering from adverse health without referring a case to the Disciplinary Committee”. 

Whereas the RCVS is responsible for protecting animals and the interests of the public, it is mandatory for the profession to protect the interests of the veterinary surgeons. With this in mind, Vets4BVU conducted an internal consultation. Based on this a response has been presented to the RCVS, a gist of which is presented for the attention of the wider profession. 

The following sections of the protocol attracted most criticism.

  • “When considering whether a veterinary surgeon’s fitness to practise could be impaired because of adverse health ..., the veterinary surgeon’s current physical or mental condition will be taken into account.”
  • “Anyone coming into contact with veterinary surgeons including ... medical practitioners, who have concerns about a veterinary surgeon’s health are encouraged to report those concerns to the RCVS as soon as is reasonably practicable.”
  • “Veterinary surgeons and veterinary nurses who are concerned about the health of a veterinary surgeon must also take steps to ensure that animals are not put at risk ... This may mean that a colleague must be reported to the RCVS.”
  • “All investigations follow a similar procedure and timeline as complaint cases not involving adverse health.”
  • “The Preliminary Investigations Committee (PIC) may... invite the veterinary surgeon to: (a) undergo medical examinations, assessments, or tests at his/her expense; (b) agree to be visited and interviewed by representatives of the RCVS; (c) provide medical reports to the PIC at his/her expense; (d) embark on a course of treatment recommended by a medical practitioner at his/her expense; and give undertakings to the PIC.
  • “If the PIC decides to invite the veterinary surgeon to give undertakings .. the undertakings may include: (a) undergoing treatment from the veterinary surgeon’s medical practitioner at his/her expense; (b) supervision from a medical supervisor appointed by the RCVS ... will not be the veterinary surgeon’s own treating medical practitioner; (c) supervision from a workplace supervisor appointed by the RCVS...; (d) specific undertakings to address concerns identified by the RCVS or the medical supervisor...; (e) undertakings allowing the sharing of information between relevant persons, for example the veterinary surgeon’s medical practitioner, employer, medical supervisor, workplace supervisor and the RCVS; and (f) submitting to blood, urine or other medical tests.”

Observations

By allowing such a free range for “anyone” to report regarding a vet’s health could potentially open the gates for malicious reporting and bolstering of other complaints by adding a suspicion or claim of a mental or physical problem with the veterinary surgeon.

There is a great concern that the terms “physical and mental condition” are too broad and could potentially be abused when reporting, given the fact that the problems of stress, anxiety and depression appear to be quite widespread in the profession.

Since the protocol does not lay the requirements of hard evidence for reporting, it is essentially unfair, unethical and potentially illegal to put a veterinary surgeon through an investigative ordeal and then to have him/her put up with the bills!

It would be breach of patient- doctor confidentiality if a medical practitioner reported a veterinary surgeon to the RCVS without informing the patient. It is not unlikely that the medical profession may have serious objections to this liability thrown at their shoulders.

Importantly, vets in dire need of medical help or advice may avoid seeing their medical practitioner for the fear of being reported, which is going to be completely counterproductive.

The RCVS will hardly have any options but to act on all reported veterinary surgeons in order to avoid potential future liability. Therefore, all reported vets will have to submit themselves to the procedures of the health protocol. This would mean that reported vets will be considered guilty unless they prove themselves to be innocent, which flies in the face of accepted standards of justice.

As it takes from several weeks to months to go from initial complaint to resolution with the RCVS, it will just impose a greater amount of stress and pressure to the affected vets, especially those with real health problems.

The protocol involves too many people – the vet, the RCVS case manager, vet’s doctor, the RCVS appointed medical practitioner, the employer, the workplace supervisor, etc. – which would clearly raise the questions of confidentiality with such a large number of people being involved.

It is hard to understand why the RCVS thinks it necessary to stipulate that a medical practitioner other than the vet’s own medical practitioner should be involved.

The veterinary surgeons required to give undertakings will feel under pressure to accept anything suggested by the RCVS for fear of facing a charge of professional misconduct should they refuse. The protocol does not provide any provisions to ensure that the undertakings are suggested on a fair basis.

It is unjustifiable to shift the responsibility of welfare of the animals under the care of a vet with suspected “adverse health” to other fellow vets and nurses.

In the absence of any independent support, if a veterinary surgeon suffering from mental or other health- related issues is subjected to the additional strain of a PIC investigation, having to undergo dictated medical assessments from assigned medical practitioners, deal with a multitude of people involved in the process, having to pay for the costs of medical assessments and treatments, having to give undertakings to whatever the RCVS suggests, and to feel forced to comply with such undertakings, will only exacerbate the problem and could push vulnerable individuals over the limits and may even provoke further tragedies of suicides in the profession.

Recommendations

  • The RCVS will need to be very specific about the problems and conditions that might attract necessary attention.
  • Only vets and nurses, working closely with a veterinary surgeon, should be allowed to report on a voluntary basis.
  • In the case of employed veterinary surgeons, fellow professionals should report the matter to the practice principal, whereas practice principals may be reported directly to RCVS.
  • If the practice principal is satisfied about the validity of the report, he/she should speak to the vet concerned in confidence and advise him/her to seek necessary medical help and monitor the progress and take care to support the vet and organise for the necessary work-related adjustments.
  • In a case where the practice principal feels that progress is not being made or does not want to deal with it directly, the principal should report this to the RCVS.
  • The practice principal should produce specified evidence to support the report; the same should apply to the direct report which involves a practice principal.
  • The RCVS should ensure that there is no conflict of interest involved between the reporter and the reported vet, for example any pre-existing internal disputes.
  • If the PIC is thoroughly convinced that the reported veterinary surgeon needs help, it should contact the concerned vet, seek his/her consent to approach the vet’s GP for a medical examination, advise the vet about work-related adjustments that may be deemed necessary and inform and advise the practice principal to implement such adjustments.
  • The cases reported under the health protocol should be dealt with on an expedited basis.
  • The entire medical process should be operated through the vet’s own GP and if necessary the RCVS can request the GP to seek further advice from a medical consultant.
  • Should the GP confirm that the vet needs medical help, arrangements for such help should be made in consultation with the GP. Any programme of treatment should be a matter exclusively between the RCVS, the vet and the GP concerned.
  • Any monitoring required at the workplace should exclusively be the responsibility of the practice principal on a very confidential basis.
  • Any undertakings required from the vet should be in consultation with the vet’s GP and that the GP should certify all undertakings are strictly indispensible.

Conclusion

In its current form the draft protocol is going to serve as springboard to plunge the affected vets deeper into their problems.

However, with modifications in line with the above submissions, the protocol will on one hand meet its objective to “protect animals and public interest” and on the other it can truly render the intended “help” to the affected vets by proactively facilitating their personal and confidential medical care.