Being struck off

Re: Being struck off

Rajat — Mon, 24 Sep 2012 18:20:07 GMT

Thank you everyone for your comments and opinions, sorry was AWOL over w/end so had to abandon VS.org - am suffering a fatal case of man flu at the mo'!

Martin no nothing personal here- I have never been drink driving or fallen under the second category either.

I think there is a difference between clinical freedom and giving something a go in the right circumstance- and blatantly performing a procedure which one cannot handle- I don't think I was clear enough in my question - I certainly didn't want to allude to more routine procedures and I should have added in not offered referral (thanks Wynne!)- for e.g. if I were to attempt an orthopaedic op tomorrow without any training CPD or an experienced vet looking over my shoulder I think this would be pretty poor- if I was the only vet in a 100 miles would I do it- of course! And likewise for other things. But if I didn't offer referral or didn't send the case to a GP colleague who does a lot of orthopaedic work I'd consider that remiss.And if the patient died, have I not brought the profession into disrepute?

But anyways - leaving all that behind - the reason I posted was because I felt depriving someone of their livelihood was quite harsh - for an offence which supposedly dishonors the profession and occurs in the individual's personal life as many have alluded to - I'm glad I'm not the only one who sees it this way.

Re: Being struck off

Bob Russell — Mon, 24 Sep 2012 15:02:51 GMT

I doubt we are that much more prone to addiction than other groups of similar professionals. We do have access to medicines that can be misused but alcohol is freely available to all.

I have not seen anything to suggest that the suicide rate amongst vets is linked to substance abuse but far more to the levels of depression and stress present (plus the accessibility to means of committing suicide).

Re: Being struck off

J G Wray — Mon, 24 Sep 2012 14:43:25 GMT

[quote user="Lorna McHardy"]which may or may not bring us to the many reasons the addiction rates are so high in this profession in the first place[/quote]

"...The level of alcohol consumption did not appear to be a negative influence on mental health within the profession as a whole. This last observation is consistent with the findings of Mellanby and others (2008) that the PMRs for alcohol-related deaths among male and female veterinary surgeons aged 20 to 64 years in England and Wales during the period from 1993 to 2005 were lower than for the general population, although the differences were not statistically significant. Harling and others (2009) explored the use of psychotropic substances among German veterinarians and found that the prevalence of smoking was lower than that in the general population, and that the prevalence of drug use was similar in both groups. However, alcohol consumption was higher among veterinarians, and the prevalence of dangerous levels of alcohol consumption was markedly elevated among female veterinarians. Hafen and others (2006, 2008) reported that one-third of first-year students at a veterinary school in the USA had symptoms of depression associated with both academic and nonacademic stressors, but it is not clear to what extent these findings can be generalised to veterinary undergraduates elsewhere..."

Hmmm - case not proven.

JGW

Re: Being struck off

Martin Atkinson — Mon, 24 Sep 2012 10:20:02 GMT

I wasn't quite sure if Rajat's OP had some personal significance, which was intriguing, but it seems probably not. However for my penno'worth I cannot see for the life of me how a one-off instance of drink driving has any bearing whatsoever on the ability of someone to perform their job even if it results in a fatal accident let alone if no incident occurred. It is no worse than using a mobile phone while driving or falling asleep at the wheel or just driving without due care - all are avoidable. It is private life which should be completely separated from professional life. I am very careful about not drink driving today but I would confess that in the distant past when rules were not so stringent I did, it is not something I am proud of its just something we did. When there was precious little monitoring of the offence was I any more or less guilty than I would now there is? And I would challenge any one who is not tee-total or totally self-righteous on this forum to say they have never driven at least once when they were not 100% sure they may fail a breathalyser.

As for point 2 there are times when we have all been forced into this scenario, in the past it was called a learning process now it is potentially professional misconduct - when did we cross that line? There is a difference between deliberately and knowingly (and most importantly -consistently) performing sub-standard care and having a go with the the best of intentions with the knowledge of the client that the outcome may be less than ideal. I did an orthopaedic op I'd never performed before last week, it turned out perfect, I'm a hero because I saved the client a mint by not referring to a specialist - would I have been guilty of misconduct if it had gone tits up?

Not guilty on both counts m'lord.

Re: Being struck off

Mark Hedberg — Mon, 24 Sep 2012 07:52:16 GMT

Certainly any sufferer of addiction needs help. Whether a vet or not is admittedly beside the point. Being struck off may be the "intervention" they need to get help; conversely taking away their livelihood could deepen the spiral of depression. (phrased in very simplistic terms, as addiction isn't quite that cut and dried. )

Re: Being struck off

J G Wray — Mon, 24 Sep 2012 07:28:59 GMT

[quote user="Lorna McHardy"]However, alcoholics need help, not their means of earning a living removing... which may or may not bring us to the many reasons the addiction rates are so high in this profession in the first place[/quote]

Are you familiar with Mr Bartram's (MRCVS) work? In light of this work , how can you substantiate this statement?

Have you worked with an alcoholic veterinary surgeon?

JGW

Re: Being struck off

Robin Grimmer — Sat, 22 Sep 2012 12:56:07 GMT

[quote user="Rajat"]

2.Operating on a patient without adequate training for that procedure

[/quote]

This certainly applied to me when I graduated as I got taught diddly-squat at university. All my surgery I have learnt post-graduation. Luckily I got the hang of things! But I think it's sad with a lot of more recent graduates who aren't prepared to try anything new and only do neuters, lump removals, dentals and the like. Who hasn't done an op for the first time with the surgery textbook open to help as you go along? Is that inadequate training? So long as you have done your homework and you are prepared. I know many vets mostly more recently qualified who won't tackle any orthopaedics, even a cruciate.

This leads to more referrals, increased costs for the client and increased insurance premiums.

Re: Being struck off

Lorna McHardy — Sat, 22 Sep 2012 10:41:11 GMT

[quote user="Rajat"]

So I wondered some time ago, what gets one struck off. Reading DC proceedings on RCVS is interesting, to say the least. I found my perceptions of what should get one struck off are different to views held by the DC@ RCVS. So here is what I wanted to ask-

Which is worse and brings the profession into disrepute (more so than the other) and why:

1.Drink driving, 2x over legal limit, no accident or injury caused to anyone including oneself.

2.Operating on a patient without adequate training for that procedure, using inadequate materials, and failing to do the op successfully, and poor technique resulting in operative complications which further risk the life of the patient.

Penny for your thoughts- it is Friday after all!

[/quote]

1) That's a criminal/legal issue and should be dealt with appropriately as such; it has tiddle all to do with the RCVS. Being drunk whilst working, on the other hand, is another matter, would certainly render someone unfit to practice, and should come within their remit. However, alcoholics need help, not their means of earning a living removing... which may or may not bring us to the many reasons the addiction rates are so high in this profession in the first place

2) Grey area, in which everyone is likely to draw their own lines. I don't think "failing to do the op successfully" is in itself a problem; and "adequate" is open to all sorts of interpretations. We are not, after all, expected to be perfect or even to perform to the highest possible level (otherwise a large number of us would be out on our ears immediately); we are expected to do what any reasonable and equivalently qualified person would do. So I'm going to sit firmly on fence and argue that there can be no blanket answer to that one... the answer is, as so often, "it depends" :0))

Re: Being struck off

Lorna McHardy — Sat, 22 Sep 2012 10:32:05 GMT

[quote user="Clive Ansell"]

anaesthetics not monitored because staff manning reception answering phones at the same time -

[/quote]

I really hate this one, and it happens a lot. The same animals often don't get monitored properly post-op for the same reason.

Re: Being struck off

Hannah Wynne Richards — Sat, 22 Sep 2012 10:16:28 GMT

To answer Rajat's original questions

Drink driving is a serious criminal offence which (imho ) ranks with attempted murder -consequences could be the same -so should automatically carry a prison sentence-but unless also including being drunk on duty, doesn't really affect fitness to practice, so on release from prison, I think the veterinary surgeon should be allowed to continue working-with the proviso that never in sole charge-so that there's always someone available who can go on visits, because veterinary surgeons not going on visits is something I feel very strongly does bring the profession into disrepute in the eyes of the public. The above, of course presupposes that magistrates will automatically take seriously their duty to protect the public-wishful thinking If they don't then,yes, I think that striking off is merited just to show that we as a profession won't tolerate such behaviour

Tackling surgery beyond one's competance level,when not having offered the owners the option of a referral is also (imho ) disgraceful professional conduct and so should merit striking off If the offer of a referral has been made, declined by the owners, and there's a signed disclaimer to that effect,then the situation is completely different-the veterinary surgeon is doing his/her best for the animal I would in these cases like to see the owners prosecuted -again wishful thinking

Wynne

Re: Being struck off

Clive Ansell — Sat, 22 Sep 2012 07:56:00 GMT

I am still unable to fathom how the RCVS DC works.

On the one hand a colleague who is found guilty and fined heavily in a court of law for causing unnecessary suffering to animals through illegal tail docking is let off, while another who cannot carry out a OOH home visit is struck off for being in a situation many of us have been in many times. Illogical

Re: Being struck off

Clive Ansell — Sat, 22 Sep 2012 07:46:01 GMT

[quote user="Rajat"]

Which is worse and brings the profession into disrepute (more so than the other) and why:

1.Drink driving, 2x over legal limit, no accident or injury caused to anyone including oneself.

[/quote]

Not sure this would deserve being struck off if a one off event or if there are extenuating circumstances. I am not condoning drink driving at all, it is a terrible and serious crime and punishment should be harsh, but it may not always make one unfit to be a veterinary surgeon.

[quote user="Rajat"]

[/quote]

Gosh - we could take half of the profession out with this one. It would alleviate the pending problem of not enough jobs I suppose?

what is adequate training? surgery training at university was effectively a correspondence course in theory only, with almost zero instruction in ophthalmology and orthopaedics (department staffed only by a resident during final year). Practical surgery training is "on the job", just get on with it and have a go in many cases, there is no formal structured or properly mentored training in place in general practice. First time I repaired an umbilical hernia (never done one before ) , I was 1 month qualified, on my own no back up, just me , and untrained nurse and textbook -thankfully it went well, but I could not claim to be properly trained or experienced at the time.

I have lost count of the number of times where practices have insufficient or inadequate materials and staff; no suture material other than catgut or nylon, reusing scalpal blades, no autoclave, no gaseous anaesthesia, no opiates, anaesthetics not monitored because staff manning reception answering phones at the same time - the list is almost endless.

Re: Being struck off

Malcolm Ness — Sat, 22 Sep 2012 07:36:46 GMT

[quote user="Rajat"]2.Operating on a patient without adequate training for that procedure, using inadequate materials, and failing to do the op successfully, and poor technique resulting in operative complications which further risk the life of the patient.[/quote]

That has been referred to as clinical freedom on other threads.

Re: Being struck off

Michael Woodhouse — Fri, 21 Sep 2012 20:10:18 GMT

[quote user="Rajat"]Other situations to replace this could include : Me attempting a TPLO without the right tools or training resulting in permanent disability or death. Or doing a phaeochromocytoma removal, never having done such major surgery before, not offering referral , not knowing the particular anaesthetic complications and requirements, leading to the patient's death. Or not giving a toss about aseptic technique (so blatant that I do not scrub my hands prior to operating, just wash them with soap and water and don't wear gloves- most of my patients are fine (and I liberally use post op antibiotics in all patients i.e. routine ops/neuters/others_and I have a death due to septic peritonitis. Should these situations lead to being struck off?[/quote]

I see it as very open to circular debate!

I strongly defend any vet's right to give things a try in situation where there is not money to refer and they have given informed consent. If you believe you are capable of a TPLO order the kit and get on with it. There had to be someone who gave the first one a try. That person hasn't then personally taught everyone else. Giving one a shot and then writing to local practices offering to do them is maybe a bit strong.

The first practice I worked at never used gloves for operating, nor did either of the two practices where I saw most practice. Now I am my own boss I wear gloves for everything. I agree that it is good (best?) practice but I don't think that should be for the RCVS to dictate. If a pyo came in tomorrow and all my surgical gloves were stolen overnight I'd still operate.

It's a bit like the controversy when the RSPCA used a captive bolt to kill some dogs. I would agree that the method was wrong in the situation, BUT if I came across a dog RTA with no hope and the only thing I had available was the bolt gun under my seat then I would use it. It should be down to the individual VS in the individual circumstances.

Re: Being struck off

Rajat — Fri, 21 Sep 2012 19:48:31 GMT

[quote user="Rajat"]

And just so it's clear- I don't take being struck off lightly, for me or anyone else- in fact it is a pretty big kick in the ***S and really should be reserved for the worst of cases! Not at all one to bay for bl

[/quote]

meant to write bay for blood but posted early by mistake

Re: Being struck off

Rajat — Fri, 21 Sep 2012 19:47:56 GMT

Re: Being struck off

Rajat — Fri, 21 Sep 2012 19:45:05 GMT

[quote user="Michael Woodhouse"]There is no excuse for drink driving, but I'm not sure it should make you unfit to practice veterinary medicine.[/quote]

I agree. I think it comes under bringing the profession into disrepute.

[quote user="Michael Woodhouse"]Just because an animal dies doesn't mean that someone has to be to blame and we have to go out blood. [/quote]

I agree with you on this too..though with the disclaimer on how and why it occurred is quite pertinent!

[quote user="Michael Woodhouse"]If the case you refer in part 2 is the glass in stomach one[/quote]

Well I confess that case got me thinking about it , but I am not really referring to this. Other situations to replace this could include : Me attempting a TPLO without the right tools or training resulting in permanent disability or death. Or doing a phaeochromocytoma removal, never having done such major surgery before, not offering referral , not knowing the particular anaesthetic complications and requirements, leading to the patient's death. Or not giving a toss about aseptic technique (so blatant that I do not scrub my hands prior to operating, just wash them with soap and water and don't wear gloves- most of my patients are fine (and I liberally use post op antibiotics in all patients i.e. routine ops/neuters/others_and I have a death due to septic peritonitis. Should these situations lead to being struck off?

Just wanted to see if I think about this differently to my peers and definitely not trying to discuss specific cases heard by the DC!

Re: Being struck off

Mark Rowland — Fri, 21 Sep 2012 19:43:00 GMT

[quote user="Michael Woodhouse"]

About the only things I think vets should be stuck off or are trust and honesty issues; serious crimes (fraud, sexual offences etc) and things like false certification.

[/quote]

And not paying your retention fees it seems. I do however agree totally about the "Out for blood " thing. We are all human after all (well most of us)

Re: Being struck off

Michael Woodhouse — Fri, 21 Sep 2012 19:33:29 GMT

There is no excuse for drink driving, but I'm not sure it should make you unfit to practice veterinary medicine.

If the case you refer in part 2 is the glass in stomach one, I have full sympathy for the vet concerned. I think at times we have all got ourselves into situations where things didn't go to plan. I don't think anyone should be struck off when they are doing their best.

Just because an animal dies doesn't mean that someone has to be to blame and we have to go out for blood.

About the only things I think vets should be stuck off or are trust and honesty issues; serious crimes (fraud, sexual offences etc) and things like false certification.

Re: Being struck off

james herriot lied — Fri, 21 Sep 2012 19:11:05 GMT

Going straight for the sense of humour failure option here, Rajat.

Drink driving can't be condoned, mitigated or otherwise normalised as a behaviour.

Sorry for the pompous post, but I feel pretty strongly on this one.