RSA Insurance Group, which underwrites pet insurance on behalf of MORE TH>N, Tesco Bank, M&S, John Lewis, Argos and Homebase, has clarified recently announced changes to its policy conditions concerning cases which need to be referred for specialist treatment.

In a letter dated 22nd May, which was sent to practices in the Midlands and the NW, the company said:

"With effect from the 25th May 2015, if you need to refer a pet under any of the above Brands to a specialist or referral vet, and the visit is not in response to an emergency, then our customer / your Client can contact us on the relevant number below before any appointment is made. We will then agree which of our preferred specialist or referral practices our customer should go to, dependant (sic) on the individual circumstance relating to the claim. If our customer does not get in touch with us or we have not agreed to the visit, then this could result in our customer suffering a financial impact. This amount will be in addition to the policy excess."

Speaking to VetSurgeon.org, Keith Maxwell, Head of Pet Claims at RSA said: "What we're saying to the primary practices is that we want to speak to our customers before they go to a referral vet. We want to engage with our customers to let them know that we have referral vets who we are starting to work with across those specific regions. We are not saying to customers that you have to use those referral vets and if you don't, we won't provide cover."

This appeared to contradict a statement that a member of VetSurgeon.org had received from John Lewis earlier which said: “If you decided to go to a specialist that wasn’t approved by us, we wouldn’t cover the costs." Keith said: "That is not correct."

Clarifying the financial impact referred to in the company's letter to veterinary practices, Keith said: "In terms of any sort of financial impact on the customer, if we think about the level of benefit that a customer will have under their insurance policy, they will have a maximum cash benefit. If a customer goes to one specific referral vet and the cost of treatment is extremely high, and they have a choice of going to a referral vet that we have been interacting with to get a like for like treatment, the cost will be lower, the financial impact on the customer will be that the overall benefit available to them will be eroded at a faster rate."

He added: "The other thing I would say is that certain customers under our policies will have a policy excess which will be on a percentage basis. Now if you think about a higher cost treatment which will incur a percentage excess, it will be a higher amount the customer will have to pay, as opposed to going to a referral vet where they can get the exact same high quality treatment, but the overall cost will be lower; they will pay a lower excess. So we are not saying we are going to penalise a customer. There are other financial consequences i.e. eroding benefit or having to pay a greater amount of excess."

Whilst RSA appears not to be removing the freedom of choice over referrals, there remains the potential for a conflict of interest when a primary practitioner recommends treatment at a centre they believe to be the most suitable for the case, and the client then rings the insurer only to be advised to use an alternative, primarily for reasons of cost. Keith said: "What I would say is that we are at the start of a journey. We've selected a small part of the country. We are very much in a 'test and learn' phase. As we have selected referral vets, we have gone through obviously quite a lengthy process of engaging with referral vets, looking at specialism, looking at their accreditation, looking at their capability, their skill, equipment within their practices, what their areas of specialism are, so we are building up this view. It does come down to we want to learn from this. We want to engage with our customers. We want to offer our customers choice. We want to make sure that our customers will not be receiving an inferior service or inferior treatment or level of specialism in any specific way."

VetSurgeon.org asked how RSA has selected its preferred referral practices, and how others can join its network. Keith said: "When we started this journey, we made contact with a significant number of referral vets across the country. Some referral vets just said point blank 'No, we don't want to talk to you'. Others said 'Yes, we'd like to come and have some discussions'. So we took those forward and then we took the referral vets through a benchmarking process based on a full list of criteria, and within RSA we have veterinary expertise helping us along that journey, so we're not just doing this on our own. We are very much an open door to interacting and liaising with referral vets."

Keith concluded by saying: "We are focused on our customers here. We are focused on making sure that pet insurance is sustainable in the long term, both for our customers and for vets across the country."

Ms Emma Bowler has been struck off by the RCVS Disciplinary Committee after multiple clinical failings.

Ms Bowler faced four sets of charges, each of which contained sub-charges, summarised as follows: 

• that between August 2018 and March 2022, she failed to provide adequate care to 18 animals on which she had performed surgery.
• that she failed to provide adequate care to a German Shepherd Cross Belgian Malinois in relation to surgery she had performed early in 2020.
• that in May 2021, when speaking to a client about surgery performed on their Jack Russell, Ms Bowler told the client that everything that had been written in the clinical records up to the point of the surgery referred to the right hind being the problem, when this was not the case and/or the veterinary surgeon who had seen the client about the x-rays prior to the surgery had not placed any notes on the file at the time the Jack Russell came in for surgery, when this was not the case.
• that Ms Bowler’s conduct in relation to the third charge was dishonest, and/or misleading.

Despite being served with the Notice of Inquiry, Ms Bowler decided not to attend the hearing due to ill-health but was represented by a counsel and solicitors.

The Committee did not find that Ms Bowler was medically unfit to attend on the basis of the medical evidence before it.

The Committee also concluded that it was in the public interest and interests of Ms Bowler to proceed with the hearing in her absence so that it could be concluded in a timely manner.  

Ms Bowler’s counsel applied for parts of the hearing to be heard in private on health grounds, which was approved by the Committee.

It was also determined that any parts in the Committee’s decision or hearing that referred to Ms Bowler’s health would be redacted. 

At the outset of the hearing, Ms Bowler’s counsel made admissions to five of the sub-charges which the Committee therefore found proven.

She also made some partial admissions in relations to a further 11 sub-charges.

After hearing a wide range of evidence, both written and oral, from Ms Bowler, the College, from clients and from an expert witness, the Committee found all charges proved except for four sub-charges.

On deciding whether the proved charges amounted to serious professional misconduct, the Committee took the following aggravating factors into account.

• In respect of charges 1 and 2, several animals suffered unnecessary injury (these charges encompassed 18 animals).
• In respect of charge 2, Ms Bowler had acted recklessly in performing revision surgery and should have recognised that she was significantly beyond her surgical ability.
• In respect of charges 3 and 4, Ms Bowler’s conduct was aggravated by her lack of integrity.
• That, overall, the misconduct spanned approximately three years and eight months and involved repetition of egregious failings.
• It was also noted that the charges encompassed multiple animals that were either caused injury or were at risk of injury.

In mitigation: 

• Ms Bowler had been working in an atmosphere that generated a highly pressurised working environment, which was somewhat unsupportive to her.
• Regarding clinical record keeping, Ms Bowler had less time available due to her heavy workload.
• Personal circumstances which exacerbated the pressures she faced at work.
• Ms Bowler had no previous disciplinary findings against her.
• She received positive character references.'
• She had made partial admissions in her statement and response to the charges and had apologised to the owners in respect of charge 2 and acknowledged that she was inexperienced in performing total hip replacements.
• Ms Bowler has subsequently made substantial efforts to avoid repetition of some of the matters encompassed in the charges.

In all, the Committee decided that the seriousness of the misconduct meant that a sanction was necessary to meet the public interest.

When deciding on whether to issue a reprimand with or without a warning, the Committee once again decided that the misconduct was too serious to allow for this.

It also decided that a reprimand and/or warning was not sufficient to protect animals and the wider public interest.

It then went onto consider whether a sanction of ‘suspension’ was sufficient but noted that it did not have enough evidence to show that Ms Bowler had shown significant insight to continue to practise unrestricted in the future.

The Committee eventually concluded that Ms Bowler’s conduct was incompatible with remaining on the Register.

Neil Slater, chairing the Disciplinary Committee and speaking on its behalf, said: “The Committee decided that the broad range of Ms Bowler’s misconduct which had spanned three years and eight months and involving injury or risk of injury to 18 animals, was incompatible with remaining on the Register and the public interest required removal from the Register even when all of Ms Bowler’s mitigation was taken into account.

“The Committee decided that it did not have sufficient evidence overall on Ms Bowler’s insight, current competence and future risk to persuade it that the lesser sanction of suspension was appropriate in this case.

“Although Ms Bowler had shown some insight, the Committee decided that she would need to have provided detailed evidence about her current practice before it could decide that she no longer represented a risk to animals in the future.

“The Committee therefore concluded that ‘removal from the Register’ was the appropriate and proportionate sanction because there had been a serious departure from professional standards, a reckless disregard for professional standards, multiple cases involving harm or risk of harm to animals and because, in Ms Bowler’s absence, it had been difficult to unravel whether she had an attitudinal problem.

“These were all factors in the Disciplinary Committee Sanctions Guidance that indicated that a sanction of removal was the appropriate sanction and, in the Committee’s decision, removal from the Register was the only sanction which would meet the public interest.

"It concluded that a lesser sanction would undermine public confidence in the profession and in the regulatory process.”

https://www.rcvs.org.uk/concerns/disciplinary-hearings 

Ceva Animal Health has taken on the exclusive distribution of Filavac, the RHDV 1 and 2 (rabbit haemorrhagic disease) vaccine.

Filavac is licensed for use in rabbits within the UK and provides 12 month's duration of immunity, allowing it to fit into annual vaccination and healthcare plans.

Filavac can be administered from 10 weeks of age with a seven-day onset of immunity. It is presented in 5 x 0.5ml single dose packs.

Nicki Glen, marketing project manager for Filavac at Ceva Animal Health said: "Rabbits are increasingly popular as household pets and should therefore become an important focus for veterinary practices. 

"We are delighted to have taken on the exclusive distribution of Filavac to provide veterinary practices with a competitively-priced and convenient vaccination for both RHDV 1 and 2."

For further information, contact your local Ceva Animal Health territory.

Nottinghamshire-based veterinary surgeon Victor Daniel Pousada Garcia has been suspended from the Register for five months by the RCVS Disciplinary Committee following a conviction for harassment.

Mr Garcia had pleaded guilty of harassment at Nottingham Magistrates Court last September and was sentenced to six weeks’ imprisonment, suspended for 12 months. The magistrates also imposed a restraining order and ordered Mr Garcia to pay compensation and costs as well as a surcharge to fund victim services. 

The harassment conviction related to incidents between 30 September 2016 and 27 December 2016 in which Mr Garcia engaged in conduct that amounted to harassment towards a woman including sending offensive text messages, visiting her place of work, attempting to contact her through social media, going to her home address and driving past her home address.

At the outset of the disciplinary hearing Mr Garcia admitted the College's charge against him and that his conviction rendered him unfit to practise veterinary surgery.

Following cross-examination of Mr Garcia on the facts of the case and having  considered representation from his counsel, the Disciplinary Committee found that Mr Garcia’s conduct leading to conviction and the conviction itself rendered him unfit to practise as a veterinary surgeon.

Mehmuda Mian, chairing the Committee and speaking on its behalf, said: "It was a serious conviction as demonstrated by the sentence imposed and by the nature of the harassment. It brought distress on [the victim] and will have damaged the reputation of the veterinary profession. The respondent was right to accept that this was the case."

Turning to the sanction for Mr Garcia the Committee considered a number of aggravating factors in his case including the distress caused to the victim as some of the text messages could be interpreted as threats to harm; the fact that Mr Garcia had continued to contact the victim after receiving a warning from the police; the fact he visited her place of work; that there was a sexual element to some of the messages he sent to the victim; and that the pattern of behaviour was sustained over three months and only ended with his arrest. It also considered that his behaviour was contrary to the Code of Professional Conduct and its supporting guidance’s advice on professional and appropriate use of social media.

The Committee also considered mitigating factors such as the fact that, during the period of his conduct, there was a family illness and bereavement; that he admitted the charges before the magistrates and the Committee; that ‘social ineptitude’ was a factor and that he did not recognise the rejection he received from the victim; testimonials as to his capabilities as a veterinary surgeon; and insight into his behaviour as well as taking steps to avoid its repetition. 

Ms Mian concluded: "The Committee has determined to suspend the respondent’s registration for a period of five months. This sanction reflects the seriousness of the conviction and the concerns expressed by the Committee in this determination. It will send a message to the respondent and to the profession that conduct such as this is unacceptable. It will afford an opportunity to the respondent to reflect further on his behaviour." 

Mr Garcia will have 28 days from the end of the hearing to appeal against the Committee’s decision.

The Committee’s full findings and decision  are available at: www.rcvs.org.uk/disciplinary

Vetopia, a 50% employee-owned European corporate veterinary group with more than 200 practices across seven countries, is set to launch in the UK this autumn with Ben Hanning MRCVS at the helm as its new Country CEO.

The company says it will be introducing a UK-specific brand in the coming months, but that each practice will retain its independence and culture.

Ben (pictured) started his career in clinical practice but has spent the past decade building and leading organisations across the veterinary and dental sectors, including laboratory services.

Ben Hanning said: “Veterinary professionals are under more pressure than ever – and I’ve lived that reality.

"Vetopia’s UK launch is about creating a new way forward: empowering vets to focus on exceptional care while giving them the support, resources and ownership opportunities that they deserve.

“Our approach is designed to provide the right balance between autonomy and collaboration.

"Together, we can nurture what makes each clinic special while ensuring every team has the tools to thrive.”

A point of difference which Vetopia says sets it apart is its ownership model, through which more than half of the company’s shares are owned by employees.

This enables vets and clinic leaders to benefit directly from the group’s success, while fostering long-term value, collective commitment and a sense of shared purpose across the network.

Peter Thomsen, Group CEO at Vetopia, said: “Vetopia’s success across Europe shows that veterinary excellence thrives when clinicians lead the way.

"Our country-led model combines local decision-making with the benefits of being part of a larger network, giving practices the freedom to deliver care their way while accessing shared expertise, investment and resources.

www.vetopia.com

The RCVS Disciplinary Committee has suspended two veterinary surgeons from the Register after finding them guilty of lying to clients and the College about the circumstances of a castration procedure which led to the death of a dog.

The Committee suspended Mr Mpho Donald Lesolle and Mr Georgi Cheshmedzhiev from the Register for four and two months respectively, following surgery undertaken on Benson, a two-year-old male Labradoodle belonging to Mr and Mrs Grayson.

During the proceedings, the Committee heard that, on 6 August 2013, Mr and Mrs Grayson brought Benson to the Swinfen Veterinary Centre in Stafford, where Mr Lesolle is the practice principal and Mr Cheshmedzhiev was his assistant, for the operation which was undertaken by Mr Cheshmedzhiev. Mr Lesolle did not directly supervise the procedure telling the Committee that he was confident that his colleague could carry out the castration, having permitted him to do so on previous occasions.

The Committee heard that, after the operation, a nursing assistant, Ms Bell, had noticed that there was blood on the bedding and that Benson had a swollen scrotum. Mr Lesolle then performed a scrotal ablation on Benson, who was discharged later that day.

However, on the morning of 8 August 2013, Mrs Grayson discovered that Benson had died during the night. An independent post-mortem concluded that he had probably died of intra-abdominal bleeding which caused circulatory collapse. Mr and Mrs Grayson raised a concern with the RCVS in September 2013.

The charge against Mr Lesolle relates to his actions following the operations and during the investigation. The four parts of the charge were that he failed to be sufficiently open with Mr and Mrs Grayson on the circumstances of Benson’s surgery; that, in September 2013, he wrote to the College indicating that he had in fact performed the castration and failing to state that there had been two operations; that, on 23 January 2014, he informed Pam Mosedale, a Veterinary Investigator employed by the College, that he had carried out both procedures; and that, on the same day, he also encouraged his veterinary nursing assistant Ms Bell to be dishonest with the College’s investigators. 

Mr Lesolle, who was present at the hearing, admitted all parts of the charge against him. He told the Committee that he decided to take responsibility for Mr Cheshmedzhiev’s operation out of a desire to protect his colleague whom he regarded as vulnerable and lacking in self-confidence. He also accepted that he had encouraged Ms Bell to lie during her interview. He told the Committee that he had persisted with the deceit until 15 January 2015, when he gave a full account of what had occurred.

The three parts of the charge against Mr Cheshmedzhiev, who was not in attendance or represented at the hearing, were that in a letter to the College sent in September 2013, he indicated that he had not undertaken the castration procedure on Benson; that on 23 January 2014 he had denied carrying out the operation while being interviewed by Pam Mosedale; and that, on 19 June 2014, while being interviewed by a solicitor instructed by the College, he said that Mr Lesolle had carried out both procedures.

The Committee found the charge against Mr Lesolle amounted to serious professional misconduct, falling far short of what is expected of a professional. The Committee highlighted the protracted nature of his deceit and the fact that he encouraged another member of staff to participate in it. However, it did accept that his motivation was to protect Mr Cheshmedzhiev.

In deciding on the sanction for Mr Lesolle, the Committee considered the aggravating and mitigating factors. Ian Green, chairing the Committee and speaking on its behalf, said: “Having taken the calculated decision to deceive the College as to what had occurred, he abused his position of responsibility to obtain support for his deceit by involving a junior employee, without any proper consideration of the effect of that decision upon her. Instead he continued with the deceit until he was presented with incontrovertible evidence that he had not carried out both procedures on the dog. In the Committee’s view he showed a wilful disregard for the College’s investigatory process.”

However, in mitigation, it also accepted that he was protecting a colleague and that there was no financial gain. It also considered his personal circumstances, the fact that he is sole principal of a small mixed practice which provides his sole source of income and that the rented accommodation also provides a home for his wife and two children. Taking all factors into account, the Committee imposed a sanction upon Mr Lesolle of four months’ suspension from the Register.

In regards to Mr Cheshmedzhiev, the Committee did not find the part of his charge relating to the letter sent in September 2013 to be proven but, in respect of the other two parts of his charge, found that his conduct fell far short of what is expected of a professional. It highlighted his willing participation in the deceit over a protracted period and his failure to take responsibility for his own involvement in the operation on Benson. 

In deciding the sanction, the Committee said that the fact that Mr Cheshmedzhiev had lied to the College’s investigators on two occasions and did not admit that he had carried out the castration and apologise for his actions until February 2015, after he had returned to his native Bulgaria, was an aggravating factor.

Ian Green added: “The Committee accepts that he allowed himself to be persuaded by Mr Lesolle to provide a dishonest account of what had taken place to the College’s investigator Mrs Mosedale, and solicitor, Mr Hudson. It also accepts that he has been described by Mr Lesolle as a vulnerable person, lacking in self-confidence in his ability to practise as a veterinary surgeon in the United Kingdom.

“Nevertheless, Mr Cheshmedzhiev accepted the obligations contained in the Code of Professional Conduct when he registered as an MRCVS, which included an obligation to cooperate honestly with the College’s investigatory process. It has also noted that he has expressed a present intention not to work in or visit the United Kingdom again.”

Taking into account all factors, the Committee decided the appropriate sanction was to suspend him from the Register for two months. 

A small animal practice in Cornwall has found that a clinical audit of its prescribing and dispensing errors resulted in 100% fewer errors and more than 50% fewer near misses.

Rosemullion Veterinary Practice is a three-site small animal practice owned by CVS.

It has 100 members of staff and dispenses 3,584 medications in an average month.

According to an article in Companion Animal, medication errors account for 30% of all reported errors in veterinary practice¹.

Errors can be prescribing errors - where the vet prescribes the incorrect medication or dosage, or dispensing errors where the incorrect medication, strength or volume is dispensed by the pharmacy team.

Some errors can ‘look or sound alike’ – where medications have similar names or packaging – making them easy to mix up.

Rosemullion conducted an initial clinical audit of entries on its VetSafe system between 1st March and 31st May 2023.

Analysis was conducted on the drugs involved, whether they were prescribing or dispensing errors or near misses, and looking for patterns of behaviour or the drugs involved.

During this time there were 29 (0.27%) near misses and 14 (0.13%) errors.

Prescribing near misses most often involved flea and worm products.

Here additional feedback from vets was that it was difficult to remember weight brackets for all products and when weight brackets were included in the drug description this made them easier to prescribe accurately.

As a consequence, the Rosemullion pharmacy team introduced the inclusion of weight brackets on all flea and worm products.

Dispensing errors and near misses were mostly related to ‘look or sound alike’, particularly in worming tablets, flea treatments and Rheumocam cat and dog.

To address this, the Rosemullion pharmacy team added extra labelling to dispensary draws and separated draws for flea and worm treatments into different weight brackets.

Rheumocam – with its similar packaging design and box sizes – was also split into separate cat and dog drawers, and drawers clearly labelled up with the version and volume to make dispensing clearer.

Feedback was also given to the drug manufacturer. 

Rosemullion also held a CPD session to highlight the common errors that were occurring, to explain resulting process and systems improvements, and ask the team to take extra care with these dispensaries.

A new ‘handing out medication’ process was also created – involving checking the medication in the bag matched the on the screen notes, confirming it was for the correct animal and validating it was what the owner was expecting.

A subsequent audit was run from 1st October to 31st November 2023.

The results revealed there were no prescribing or dispensing errors (0%) and only 8 (0.13%) near misses during this time.

Alice Bell, Senior Vet and Quality Improvement Lead at Rosemullion Veterinary Practice, said: “We place patient safety at the forefront of all we do.

"We wanted to conduct this extensive audit to assess our prescribing and dispensing processes and systems.

“The methods we had in place made it easy to do the task correctly and the changes we have now put in place have made the process even safer for our clients.

"Our overall error and near miss is now at a really low number compared to our total number of medication dispenses.

“The teams have been very receptive to the improvements and the project has had a positive impact on various aspects of the practice, including on team wellbeing.”

Rosemullion Veterinary Practice’s initiative has recently been recognised with a RCVS Knowledge Highly Commended status at its 2024 awards.

Reference

1. Mosedale, Pamela & Blackie, Kathrine. (2021). Why do medication errors occur in veterinary practice?. Companion Animal. 26. 1-4.https://doi.org/10.12968/coan.2021.0033 

The British Association of Homeopathic Veterinary Surgeons is claiming that: "owners can now be confident homeopathic medicines can be effective for common canine and feline conditions in many animals, following a recently published clinical study." 

In what the BAHVS says was the largest-ever study of its type, the Clinical Outcomes survey has identified a number of clinical conditions in dogs and cats that homeopathic veterinary surgeons believe may be promising targets for future research in veterinary homeopathy. 

In the study, twenty-one homeopathic vets in the UK recorded data from their patients over a 12-month period, and collected information from a total of 1500 dogs and 400 cats. The most frequently treated feline conditions overall were dermatitis, renal failure, overgrooming, arthritis and hyperthyroidism.  The most commonly recorded canine conditions were dermatitis, arthritis, pyoderma, colitis and fear. By owners' assessments, a moderate or major improvement was reported overall for 68% of dogs and 63% of cats.

The authors of the study concluded that a programme of controlled research in homeopathy for frequently-treated feline and canine conditions is clearly indicated.

John Alborough, co-publisher of VetSurgeon.org said: "I also find that if I shove toenail clippings up my bottom, it totally cures my indigestion."

Reference
Mathie RT, Baitson ES, Hansen L, Elliott MF, Hoare J. Homeopathic prescribing for chronic conditions in feline and canine veterinary practice. Homeopathy 2010; 99: 243-248.

Virbac has launched Sulfatrim, the first veterinary-licensed Trimethoprim and Sulfamethoxazole (TMPS) oral antibiotic for use in rabbits, pigeons and bearded dragons.

Kate Woolley MRCVS, Product Manager, said: "Until now, no similar veterinary-licensed product has been available for these species and, in an environment where vets are increasingly aware of the responsible use of antibiotics across all species, we are very happy to launch Sulfatrim, the first licensed TMPS for rabbits, pigeons and bearded dragons."

Sulfatrim is presented in a 30ml bottle with a dispensing cap and syringe. 

Elanco Animal Health has launched Vulketan, a POM-V sterile topical gel developed to encourage the healing of equine wounds.

Vulketan contains ketanserin - a serotonin-S₂ antagonist.² Elanco says that although serotonin is more widely known as a neurotransmitter in the brain, it is also found in platelets and released during platelet aggregation where it can have negative effects on wound healing.^{4, 7}

Managing equine wounds is an everyday occurrence in equine practice¹ and can be difficult and time-consuming, with many potential complications such as infection or the development of proud flesh which could delay healing or lead to reduced functionality. Repeated dressings can be a hassle for owners, and if used inappropriately can lead to their own complications.⁵

Elanco representative Kirsty Prudon said: "Vulketan gel is easy to use and is designed to be applied to undressed wounds, although it has been demonstrated that wounds may be dressed, if required, without affecting Vulketan's efficacy^2,6.

Elanco also points to studies which it says demonstrate that Vulketan has been shown in client owned horses to be highly effective in preventing the formation of hypergranulation tissue and may facilitate the control of secondary infections.^2,3,6. In addition, owners expressed satisfaction with Vulketan in over 90% of cases.⁶

Practising equine vet Linda Belton MRCVS said: "Vulketan is easy to use, well tolerated by horses and produces an excellent end cosmetic result and return to function. With the reduction in the need for dressings and proud flesh control Vulketan has proven to be an advantageous product which owners value."

Vulketan is suitable for use in all horses including pregnant and lactating mares. It is supplied in 75 gram tubes and should be applied twice daily.

For more information, contact your Elanco territory manager call Elanco on 01256 353131.

References

• Elanco. Market Research: Vulketan Gel in horses. A survey of 153 Vets across France, Germany and UK. 2011
• Elanco. Vulketan Summary of product characteristics. Dec 2013
• Engelen M, Besche B, Lefay M-P, Hare J, Vlaminck K. Effects of ketanserin on hypergranulation tissue formation, infection, and healing of equine lower limb wounds. Can Vet J 2004; 45: 144-9
• Janssen PAJ, Janssen H, Cauwenbergh G, De Doncker P, De Beule K, Lewi P et al. Use of topical ketanserin in the treatment of skin ulcers: a double-blind study. J Am Acad Dermatol 1989; 21: 85-90
• Stashak TS, Selected factors that negatively impact healing. In: Equine Wound Management 2nd Ed. Eds. TS Stashak and CL Theoret. Wiley-Blackwell, 2008, pp. 71 - 84
• van Gulik IB,Vinke HE,Cieslicki M. Effect of ketanserin on wound healing in horses, Der Praktische Tierarzt Heft 9, S. 802 ff. 93. Jahrgang 2012
• Vlaminck K. Effects of the S2-antagonist ketanserin on wound repair in horses. Proc 1st World Congress of Veterinary Dermatology, Dijon, France. In: Advances in Veterinary Dermatology 1. Eds. C von Tscharner, REW Halliwell, Ballière Tindall, 1989 pp. 221-5.

Suffolk-based Dr Horia Elefterescu has been struck off by the RCVS Disciplinary Committee for dishonesty, clinical failings and poor record keeping.

The Committee heard seven charges against Dr Elefterescu. The charges were:

1. In September 2015, in relation to a male cat called Kitty Brown, he failed to undertake an adequate examination prior to surgery and that he undertook an unnecessary laparotomy.

2. In February 2016, in relation to a male cat called Storm Page, he failed to undertake an adequate clinical examination prior to anaesthesia and made dishonest or misleading entries in the clinical records stating that he had undertaken a full clinical examination.

3. In February 2016, in relation to a male cat called Sampson Page, he failed to undertake an adequate clinical examination prior to anaesthesia and made dishonest or misleading entries to the effect that he had undertaken a full clinical examination.

4. In February 2016, in relation to Tibial Plateau Levelling Osteotomy (TPLO) surgery performed on a female Bichon Frise called Lucy Allen, he failed to undertake adequate examinations into the possibility of a cranial cruciate ligament rupture or failed to record the same; performed the TPLO surgery with insufficient clinical justification; performed the surgery inadequately; failed to take steps to rectify inadequate surgery having obtained post-operative radiographs; made dishonest/ misleading entries into clinical records; and, in a letter to the RCVS on 7 August 2016, made dishonest and misleading comments.

5. In February 2016, in relation to a male cat called Kipper Morley, he failed to take and record a sufficiently detailed history; failed to undertake an adequate clinical examination; that, having noted the possibility that Kipper might have anaemia, he failed to make arrangements for urgent investigations to be undertaken; that, having decided to administer intravenous fluids to Kipper, failed to make arrangements urgently; and failed to keep clear, accurate and detailed clinical records.

6. Between September 2015 and February 2016, he failed to keep clear, accurate clinical records in relation to seven cases.

7. In February 2016, in relation to a male cat named Chino Biggs, he failed to undertake adequate clinical examination and dishonestly made entries in the clinical records saying that he had undertaken aspects of an examination when he had not done so.

Having heard evidence from complainants, witnesses (including expert witnesses) and the respondent himself the Committee determined that the facts of all the charges were proven – with the exception of part of Charge 6 regarding his keeping inadequate clinical records in relation to a male cat called Dax Parham.

The Committee then went on to consider whether the proven charges, both individually and cumulatively, amounted to serious professional misconduct. In relation to the first and fifth charges the Committee found that, while Dr Elefterescu’s conduct fell below what was expected of a professional veterinary surgeon – they did not constitute serious professional conduct.

In relation to the parts of the second, third, fourth, sixth and seventh charges that were found proven, the Committee determined that each constituted serious professional misconduct. 

In relation to these determinations, Ian Arundale, chairing the Committee and speaking on its behalf, said: "The respondent’s clinical failures… are very serious, amounting as they do to failures in the basics of animal care and resulting in suffering to the animal. They involve widespread breaches of the Code, including not only the obligation in relation to animal health and welfare… but also the specific obligations of the Code in relation to record keeping. 

"In addition to his clinical and record keeping failures the respondent has been found to have acted dishonestly. This dishonesty would have impacted upon professional colleagues and any owner who viewed the records. It has the potential to undermine public confidence in the profession. The respondent was also dishonest in a letter written in August 2017 to his regulator."

In considering Dr Elefterescu’s sanction, the Committee took into account a number of aggravating and mitigating factors.

Aggravating factors included actual and risk of injury to animals, dishonesty, recklessness, breach of client trust, repeated misconduct and limited insight into his failings.

In mitigation the Committee considered that, at the time of the misconduct, the respondent was new to the UK, he had language difficulties which resulted in communication problems, that he was unfamiliar with UK veterinary computer systems and procedures, that he is of good character, that he has taken steps to avoid a repetition of his misconduct and that there have been no subsequent complaints since the dates of the matters in the charges.

However, the Committee found that, in light of the seriousness of the charges found against him, the only sufficient sanction was to direct the Registrar to remove Dr Elefterescu’s name from the Register. 

Mr Arundale, commenting on the sanction, said: "The respondent’s misconduct involved very serious departures from the professional standards set out in the RCVS Code…. In particular, the unnecessary surgery (both the initial and revision) carried out on Lucy Allen constituted very serious harm to an animal. The Committee considers that the respondent’s lack of insight into his failings, and his wholly unjustified confidence in his abilities constitute an ongoing risk to animal welfare. In these circumstances, the Committee has determined that the only sanction which is appropriate and proportionate, in order to ensure the welfare of animals, the public interest and the reputation of the profession, is to direct the respondent’s removal from the Register."

Dr Elefterescu has 28 days in which he can lodge an appeal with the Privy Council regarding the Disciplinary Committee’s decision.

A Kent-based veterinary surgeon who faced allegations relating to multiple clinical failings has been removed from the Register at his own request. 

George Philippus Hauptfleisch faced three charges in relation to allegations of clinical failings surrounding three patients:

The first charge surrounded the allegations that in 2018, Mr Hauptfleisch failed to provide appropriate and adequate care to Steel, a Cane Corso Mastiff, in that he performed surgery outside of his competence, failed to offer a reasonable range of treatment options as alternatives, failed to make adequate enquiries about the possibility of a referral to a specialist, failed to obtain informed consent to the surgery, and failed to maintain adequate clinical records.

The second charge, in relation to a German Shepherd, alleged that in 2019, Mr Hauptfleisch failed to provide appropriate and adequate care when he undertook surgery which was outside of his competence and failed to undertake the surgery to an adequate standard, failed to note sufficient details to show that informed consent for the surgery had been obtained, and failed to maintain adequate clinical records.

The third charge, in relation to a Retriever, alleged that Mr Hauptfleisch failed to provide appropriate and adequate care with regards to surgery he performed when it was outside of his competence, failed to undertake the surgery to an adequate standard, failed to note sufficient details that showed informed consent had been obtained, and failed to maintain adequate clinical records.

Prior to the hearing, Mr Hauptfleisch made an application to the Committee to dispose of the matter by way of adjournment for an indefinite period, against his undertakings to request the Registrar to remove him from the Register, and never to seek restoration to the Register.

In deciding whether to grant the application, the Committee took into account a number of factors.

These included the fact that Mr Hauptfliesch had, in December 2021, returned to South Africa, after a career of over 32 years in the UK, and now resides there permanently, the fact that he has no intention of moving back to the UK, and that he had not practised as a veterinary surgeon since the day he left.

He had also removed himself from the equivalent register in South Africa and the Committee noted that the RCVS would inform the South African Veterinary Council of the outcome of these proceedings.

The Committee also noted that there were no previous disciplinary findings against him,  that Mr Hauptfleisch now spends the majority of his time undertaking charitable activities, including running a mentoring programme for young people, and, that he expressed deep regret for anything which he did or did not do which failed to protect the welfare of animals or caused upset to his clients and fellow members of the profession.

Mr Hauptfleisch also drew attention to the fact that the charges did not allege dishonesty and that the reputation of the profession would be upheld as Mr Hauptfleisch would no longer practise as a veterinary surgeon and would not return to practise.

Therefore, it would not be proportionate, nor in the public interest, for there to be a lengthy contested hearing resulting in substantial costs for both the RCVS and for Mr Hauptfleisch.

Hilary Lloyd, chairing the Committee and speaking on its behalf, said: “Taking into account the removal from the Register and the respondent’s undertaking never to apply for restoration, in conjunction with all of the circumstances, the Committee was satisfied that allowing the application would be sufficient to uphold the public interest, confidence in the profession and the RCVS as a regulator, and protect the welfare of animals.

“As a result of all the factors set out, and taking into account the nature of the charges which relate to the alleged inadequate standard of clinical practice, the Committee decided that this is not a case in which there were wider issues relevant to the profession at large, such as those which had public policy implications and which required full consideration at a hearing.

“The Committee was satisfied that neither the public interest nor the welfare of animals demands that there be a full hearing in this case.

“Taking into account proportionality and weighing in the balance all the circumstances of the case, the interests of justice, the public interest, the need to uphold proper standards of conduct and performance, and the need to protect the welfare of animals, the Committee decided to grant the respondent’s application.”

https://www.rcvs.org.uk/concerns/disciplinary-hearings/