Chikosi Suggestion Box

Re: Chikosi Suggestion Box

Anthony Todd — Thu, 18 Jul 2013 20:17:29 GMT

[quote user="glen mcintosh"]The vet in this scenario is being blatantly dodgy. Assuming the client makes an RCVS complaint, I think the only option available to the DC would be to go after the vet on the basis of bringing the profession into dispute by charging excessive fees.[/quote]

I agree but the RCVS has always said fees are a civil matter and refuse repeatedly to get involved and I think they are wrong.

Re: Chikosi Suggestion Box

Anthony Todd — Thu, 18 Jul 2013 20:15:48 GMT

[quote user="glen mcintosh"]If you have judged the house visit to be clinically essential [/quote]

I think that should be "if you have judged the house visit to be essential because the animal is suffering" rather than "clinically essential" [say a large mammary tumour, as an example]

Re: Chikosi Suggestion Box

Glen McIntosh — Thu, 18 Jul 2013 18:46:29 GMT

[quote user="Anthony Todd"]

If a vet, who doesn't want to do a visit, quotes an outrageous fee, say not £600 but £1200 in the case in question and the client refuses topay that fee and says [again] "I'll see how the dog is in the morning" where does the vet stand?

The vet didn't refuse the service, the client refused to pay the fee and cancelled the visit.

[/quote]

Hmmm, good question, but a bit of a curly one.

The vet in this scenario is being blatantly dodgy. Assuming the client makes an RCVS complaint, I think the only option available to the DC would be to go after the vet on the basis of bringing the profession into dispute by charging excessive fees. It would be harder to successfully prosecute the vet on charges of causing unnecessary suffering (assuming that this occurred in this scenario as a result of the failure to perform the house visit) in this scenario, since the owner declined the visit. In this case, the owner is responsible for the unnecessary suffering of the animal because the owner has placed financial considerations before the welfare of the animal, even though the vet is dodgy. The owner should have just paid the bill, got the animal sorted, then pursued recompense from the vet at some later stage via the courts or some other such body.

The more relevant question (since I make the assumption that none of us are blatantly dodgy), though, is what happens in the case where the fees are justifiable, the house visit judged clinically essential but the client refuses to pay because they think the fee is outrageous and says "I'll see how the dog is in the morning". Based on the logic of the dodgy vet scenario above, in the justifiable fee scenario if the client complains to the RCVS I think the vet should be safe from disciplinary action because the owner has assumed responsibility for the animal's welfare by declining the visit, and the client is responsible for any unnecessary suffering of the animal since they have put financial considerations before the welfare of their animal. That is, it is not that the client can't pay, but that they won't pay.

If the client declines the visit then you really have no right to enter the clients property, even if you still wanted to. So in both scenarios, if you judged that a house visit was really clinically essential and you felt the animal's welfare was compromised by it not receiving veterinary treatment at the clients home, then you might be obliged to contact the Police or RSPCA whose inspectors do have the right to enter private property on the basis of a suspicion of animal cruelty. You might then be asked to perform the house visit by the Police or RSPCA. You would need to oblige that visit request, but your fees would be paid.

Of course, in the first scenario you are dodgy, so you wouldn't bother calling the RSPCA or the Police.

[quote user="Anthony Todd"]Of course there is a corollary to that ; if the client says "I can't pay that, but the animal is suffering [or gives a description which makes the vet believe that the animal is suffering] where does the vet stand?[/quote]

This one is easier. If you have judged the house visit to be clinically essential and the client says that they are unable to pay the fee, then you perform the visit anyway, and sort out payment at some later date, either through a payment plan, a debt collection agency or the courts. You probably won't get paid at all in many of this type of case. If you refuse to do the visit then you could be charged with causing unnecessary suffering, if that was the result of your refusal to visit, and you would most likely be found guilty at your DC hearing. By refusing to do the visit because the client cannot pay, a visit that you have deemed clinically essential, means that you have placed financial considerations before the animal's welfare needs. This is directly in conflict with the Code.

But I could, of course, be talking complete nonsense, so I would be keen to hear other peoples views, especially alternative arguments.

Re: Chikosi Suggestion Box

Rob Loxley — Thu, 18 Jul 2013 17:36:37 GMT

[quote user="Malcolm Ness"]eg Vet on call with a car that is insured for private use only[/quote]

A bit of an aside, but it costs me very little to add business class 1 cover on top of SDP&C on my car insurance. I usually cycle to work and we have a practice vehicle, but occasionally I have used it for home visits

Re: Chikosi Suggestion Box

Kishor Mahind — Thu, 18 Jul 2013 17:19:17 GMT

[quote user="Hannah Wynne Richards"]

What if the owner hasn't a car? Can't afford a car? Would you say that car manufacturers should be FORCED to sell cars at less than cost price? That's no different to saying that Royal College should force veterinary practices to provide services at less than cost price.

Wynne

[/quote]

No, if the owner cant afford a car or a taxi, or cant afford to look after their pet (veterinary fees/ insurance/ preventative healthcare / cost of emergency treatment) then they should not be owning a pet...pet ownership is not a right, its a privilege. It is irresponsible ownership if you have a large dog or a fancy breed for which you cant take care of the costs involved in the ownership. If the owner cant afford a car insurance for say for example a BMW sports sedan then will they still go and buy it???

Re: Chikosi Suggestion Box

Anthony Todd — Thu, 18 Jul 2013 17:12:28 GMT

[quote user="Hannah Wynne Richards"]Yes. As it happens I do think the veterinary surgeon would be entitled to refuse.[/quote]

But I'm asking about the exact opposite, I'll try again.

If a vet, who doesn't want to do a visit, quotes an outrageous fee, say not £600 but £1200 in the case in question and the client refuses to pay that fee and says [again] "I'll see how the dog is in the morning" where does the vet stand?

The vet didn't refuse the service, the client refused to pay the fee and cancelled the visit.

Of course there is a corollary to that ; if the client says "I can't pay that, but the animal is suffering [or gives a description which makes the vet believe that the animal is suffering] where does the vet stand?

Re: Chikosi Suggestion Box

Hannah Wynne Richards — Thu, 18 Jul 2013 17:00:43 GMT

Yes. As it happens I do think the veterinary surgeon would be entitled to refuse. It's not a justifiable or sustainable businessmodel , if a practice is forced to provide a service at less than cost price. Vets Now employees have explained how the fully justifiable expenses add up. If they want to do it for less,as a loss leader-then fine. Forcing them to do it for less is unjustifiable. Remember that every "freebie" or loss leadre means that fees for something else must go up.

I've criticised veterinary surgeons who refuse to do house visits. Some have said the onus of bringing the animal to the veterinary surgeon should be the owners.

Wynne

Re: Chikosi Suggestion Box

Anthony Todd — Thu, 18 Jul 2013 16:30:56 GMT

[quote user="Hannah Wynne Richards"]I feel the fee is fully defensible.[/quote]

I'm not talking about fee-fixing or a cartel all I am asking , as an example is if the fee quoted for the case in question was, say £1200 and the client refused would the vet be justified in not attending as the client had refused the visit and said "we'll see how the dog is in the morning".

This certainly happened to me when the fee was much much less.

I'm not criticising the £600 fee for the case in question.

And red stars don't really make any contribution to the discussion 'cos no one knows why, unless I'm being offensive which, this time, I'm not.

And immediately I get 5 gold; I just don't get it, and it wasn't me either!

Re: Chikosi Suggestion Box

Glen McIntosh — Thu, 18 Jul 2013 16:06:51 GMT

[quote user="Hannah Wynne Richards"]

That's because very few MOPs have the faintest idea of the COSTS of running a business. If the call out/OOH charge is clinically justifiable-as Mr Chikosi's was-then if the animal was insured, the insurence company would pay. If it isn't necessary, maybe they would decide to bring it in when told the cost. If it wasn't insured-well that's definitely the owner's fault-not the veterinary surgeon's -so there is no possible moral justification for the veterinary surgeon suffering financially for someone else's irresponsibility.

Wynne

[/quote]

I find myself in complete agreement with you Wynne.

Perhaps I have banged my head on something??

Re: Chikosi Suggestion Box

Glen McIntosh — Thu, 18 Jul 2013 16:01:58 GMT

[quote user="Hannah Wynne Richards"]

Don't die from shock,everybody!!!!!!!!!!!!!!!!!

I really,really don't want to be accused of mass manslaughter!!!!!!!!!!!!!!!!!!!!!!!!!!!!

For once, I'm defending Vets Now.

[/quote]

Seriously though, have you banged your head on something recently?

Re: Chikosi Suggestion Box

Hannah Wynne Richards — Thu, 18 Jul 2013 15:50:08 GMT

Wynne

Re: Chikosi Suggestion Box

Anthony Todd — Thu, 18 Jul 2013 15:42:45 GMT

[quote user="Hannah Wynne Richards"]The responsibility for providing the service/treatment is ours. The responsibility for paying for it is the owners.[/quote]

So everyone seems to be saying that there is no such thing as a constructive refusal by way of a large fee in the MOP's view?

Re: Chikosi Suggestion Box

Hannah Wynne Richards — Thu, 18 Jul 2013 15:20:08 GMT

Don't die from shock,everybody!!!!!!!!!!!!!!!!!

I really,really don't want to be accused of mass manslaughter!!!!!!!!!!!!!!!!!!!!!!!!!!!!

For once, I'm defending Vets Now. I would have done this visit, and euthanasia for considerably less. £190.70+ VAT=£228.84. A farmer should be VAT registered, and a collie a farm dog, so the VAT would not really matter in this case. Admittedly, I would have gone without a nurse-which is one factor in keeping costs, and therefore fees down. If I had felt it was a dodgy area, or dodgy client, and so called my nurse out, the fee would have gone up by £83.58 +VAT=£100.29.

However-my costs would be far lower than Vets Now-so I would defend their fees as expensive, but fully justified. It isn't right that either professional employees should be expected to work for peanuts- or that business people should be expected to perform services at less than cost price.

The responsibility for providing the service/treatment is ours. The responsibility for paying for it is the owners. Given Vets Now costs, I feel the fee is fully defensible.

It would be both immoral,and illegal for Royal College to become involved in fee fixing. Immoral-because forcing someone to work for nothing, is as good a definition of slavery as I've come across yet. Illegal, because price fixing is illegal-end of. It doesn't matter in the slightest if the fixing is fixing up(business people benefit) or fixing down( public benefit), it's still illegal.

Wynne

Re: Chikosi Suggestion Box

J G Wray — Thu, 18 Jul 2013 14:38:39 GMT

[quote user="glen mcintosh"]The RCVS can certainly investigate and discipline vets who charge fees that are so grossly excessive that they bring the profession into disrepute.[/quote]

Ah one remembers the complaint Pet Protect made about the then serving RCVS Councillor Mr Bailey. He abased himself and the complaint went no further. It was all a bit odd in respect of process, because PI process is not too public and he didn't get to DC, yet one and all got to hear about it.

JGW

Re: Chikosi Suggestion Box

Glen McIntosh — Thu, 18 Jul 2013 13:52:39 GMT

[quote user="Anthony Todd"]So if I say [were I still in the game] that, "yes, I will visit your cat that is poorly and be there within one hour after I have arranged cover at my OOH clinic and my fee is £800 plus VAT " then I have fulfilled my legal and ethical responsibilities?[/quote]

No, if you assessed the house visit as being clinically essential then you would need to perform the house visit irrespective of the clients ability to pay.

My practice, and the practice I recommended to locums and new staff at induction, was not to discuss the cost of the house visit until YOU, the vet had either decided it was clinically essential to attend the house visit or decided to attend the house visit for some other reason. But it was very important that the client be made aware of the cost prior to proceeding. Taking full payment prior to attending was also recommended.

If the client explained that they were unable to meet the cost, and YOU, the vet, still believed the visit to be clinically essential then you could advise the client that you would still make the visit and payment could be sorted out at some later stage, but making it clear to the client that they would still be liable for the cost.

If the client said something along the lines of "that is outrageous, there is no way I am paying that", previously (prior to Chikosi) I would have explored with the client the possibility that they might be having financial difficulties and if so proceed as per above. If they still said, "no, I just think the price is outrageous", then I would have told the client that by refusing to make payment they are, in effect, refusing my offer of a house visit and advised them that I would not be attending the house visit if they did not pay - in advance. Maybe I would notify the RSPCA and ask for an inspector to visit the client with regards to the animals welfare if I thought that was warranted.

The above (about clients refusing to pay because they thought the cost was outrageous) is theoretical since it was not something that I had ever needed to apply in practice. A lot of clients would complain afterwards though.

Post Chikosi and Albring I am less confident that it would be a professionally safe approach.

But there is no issue of "constructive refusal" or denying treatment because of financial concerns if the above approach is used, and I doubt that this approach has changed much since I left.

[quote user="Anthony Todd"]Dare I suggest "excessive" fees brings the profession into disrepute as much as anything else?[/quote]

The RCVS can certainly investigate and discipline vets who charge fees that are so grossly excessive that they bring the profession into disrepute.

The charges made by Vets Now for house visits, at least when I was working there, were demonstrably justifiable since they would barely cover costs. Phil Hyde, around 752 posts ago, gave an excellent exposition on the cost of OOH emergency house visits. The charge is set neither to be profit making nor deterrent, simply to cover cost. And don't forget, the circumstances where this charge should be made (ie clinically essential house visits) should be very rare, so it will never be a significant income source for an emergency clinic. I think that the $600 in the Chikosi case would include the house visit surcharge, the OOH fee, the consultation fee, the euthanasia fee and materials cost and possibly even the cost of cremation. So it is not just the house visit fee.

So I think the RCVS would really struggle to make a case that these fees are so excessive as to bring the profession into disrepute. But, then again, the RCVS has recently demonstrated a remarkable capacity for creativity when it comes to potting vets, especially when it involves house visits.

Re: Chikosi Suggestion Box

sam aldridge — Thu, 18 Jul 2013 13:06:50 GMT

The costs do actually come to that. Again I work for vets now. To get a vet for 2 hours at 3am (and often a nurse as well) you cannot pay a standard hourly rate you would for a full shift. How many would get out of bed for £50-60? We pay a significant amount more for this to get the staff. Often the combined bill for the staff coming in is £250/300. The taxi is at least £50 (one recently £140). This is what makes up the home visit surcharge. On top of that the usual consult fees for professional time and the service/drug charges that apply for any case (eg euthanasia). Expensive yes, but not unjustifiable and not a money making exercise and not designed just to put people off. We often make significantly less on any home visit especially when time taken to organise it is factored in as well as inflated taxi fees.

Re: Chikosi Suggestion Box

Mark Holmes — Thu, 18 Jul 2013 12:52:07 GMT

[quote user="Anthony Todd"]

[quote user="Hannah Wynne Richards"]

Fees are none of the business of Royal College.

Wynne

[/quote]

Bah humbug!

So if I say [were I still in the game] that, "yes, I will visit your cat that is poorly and be there within one hour after I have arranged cover at my OOH clinic and my fee is £800 plus VAT " then I have fulfilled my legal and ethical responsibilities?

It's constructive refusal and the RCVS should recognise it as such and not duck the issue.

Dare I suggest "excessive" fees brings the profession into disrepute as much as anything else?

And I wish the poster would have the ballonies to justify my previous red star.

[/quote] But if you can demonstrate this is what home visits cost, should we be required to do it for less than cost? Once additional staff, taxis (or the costs if a vehicle with no other purpose) and covering the bad debt that these visits tend to generate have all been considered I suspect the costs do come to this sort of figure.

Re: Chikosi Suggestion Box

Anthony Todd — Thu, 18 Jul 2013 12:35:18 GMT

[quote user="Hannah Wynne Richards"]

Fees are none of the business of Royal College.

Wynne

[/quote]

Bah humbug!

It's constructive refusal and the RCVS should recognise it as such and not duck the issue.

Dare I suggest "excessive" fees brings the profession into disrepute as much as anything else?

And I wish the poster would have the ballonies to justify my previous red star.

Re: Chikosi Suggestion Box

Hannah Wynne Richards — Thu, 18 Jul 2013 12:21:21 GMT

Fees are none of the business of Royal College.

Wynne

Re: Chikosi Suggestion Box

Anthony Todd — Thu, 18 Jul 2013 11:31:32 GMT

[quote user="Malcolm Ness"]I agree completely - you may recall that about 847 posts back I pointed out that Chikosi had done us all a great disservice by failing to make a defence[/quote]

I agree with all of that but I would hope that:

1. Mr Chikosi is not answering his phone, so far. Did the DC even try? Is he alive?

2. The RCVS will, in the fullness of time, but hopefully sooner, give more specific guidance and be more mindful of the complex nature of OOH visits, from staffing to motoring and define MsOP's responsibilities.

3. There has been no comment on a constructive refusal by way of an enormous fee. What is the DC's view on an "impossible" fee?

Re: Chikosi Suggestion Box

Malcolm Ness — Thu, 18 Jul 2013 11:13:17 GMT

[quote user="Anthony Todd"]

There is another aspect [sorry]

Assuming I am correct in believing that the fee charged in the Chikosi affair was £600 doesn't anyone think that this is a constructive refusal by reason of the enormous fee?

How many "clients", registered or not [and that hasn't been elucidated either] can afford, let alone have £600, a fee worthy of a Chelsea emergency plumber!

[/quote]

I agree completely - you may recall that about 847 posts back I pointed out that Chikosi had done us all a great disservice by failing to make a defence. Consequently nobody was able, as part of the DC process to explore this aspect. Similarly, an opportunity to explore the good points raised by Glen Mc with respect to what could be offered as a reasonable defence for NOT doing the visit either at all or with a delay while other duties were dealt with was lost.

I do have considerable sympathy for individual vets placed in the iniquitous situation of having unlimited responsibility but severely limited power - even if some of that restriction on their power is only implied rather than documented. This is a subject that is long overdue for an airing and it is a shame that the particularly unusual circumstances of the Chikosi case has been the catalyst for the discussion. As well as the vets working in deputising services with a perceived no visits policy, there are many working in private practices where there might be an effective no visits policy (eg Vet on call with a car that is insured for private use only and no written scheme to allow the use of a practice vehicle or hire-in a taxi etc etc) and these vets will struggle to defend their actions should they come across the rare case that does need a visit. And then there are the charity clinics - whether or not the charity clinics should be exempt from the duty to do visits is another separate discussion but it is overwhelmingly obvious that a vet currently working OOH at any of the UK charity clinics could encounter a situation where a visit is needed and they would be expected to have arrangements in place to deal with the admittedly very unlikely scenario. I have been told on several occasions by several different vets that they don't do visits "because they are a charity clinic". My understanding is that if the sh*t hits the fan, it is the individual vet who will be held accountable. Hopefully, those currently exposed to this jeopardy, whether in a deputising service, a charity clinic or an "ordinary" practice will review their situation and then sit down with their employers to make sure that there are no misunderstandings.

Re: Chikosi Suggestion Box

Jenny Smith — Thu, 18 Jul 2013 11:02:23 GMT

Sorry for no paragraphs, on my iPhone. I work for VetsNow, I'm about to become a dreaded line manager. And last week I dropped everything and was out the clinic within 15 minutes for a visit. The fee is high because it covers the cost of getting in a vet (staff or locum) to cover the clinic while we're away and the cost of getting to and from the visit (we use taxis as our cars don't have business insurance) as well as a charge for the additional professional time a visit takes. If my typical OOH consult is £130 for say 20 minutes then me being out of the clinical for 1-1.5 hours (including travel) surely constitutes chargeable professional time. My case was an RTA on the motorway, with the only information I had that the dog had been ejected from the car which the owners were currently bring cut from. Luckily pooch was absolutely fine and sitting wagging in the back of a police car when I arrived. So on reflection... Clinically necessary, no. But I couldn't have made that judgement on the information I had (the highways agency contacted us) at the time of the call. P.s vets now isn't a corporate, owned by a vet, managed by vets and all the line managers (district and in clinic) are vets!

Re: Chikosi Suggestion Box

Gerbil — Thu, 18 Jul 2013 10:24:20 GMT

Depends if they are going to pay or not I would hazard a guess that they are making some sort of legal pursuit against Vets Now. Mr Chikosi is probably beyond their reach now.

Re: Chikosi Suggestion Box

Anthony Todd — Thu, 18 Jul 2013 09:56:24 GMT

There is another aspect [sorry]

Assuming I am correct in believing that the fee charged in the Chikosi affair was £600 doesn't anyone think that this is a constructive refusal by reason of the enormous fee?

How many "clients", registered or not [and that hasn't been elucidated either] can afford, let alone have £600, a fee worthy of a Chelsea emergency plumber!

Re: Chikosi Suggestion Box

Mark Hedberg — Thu, 18 Jul 2013 07:06:14 GMT

[quote user="glen mcintosh"]

So, here is another way of looking at this case:

Say that I was in an identical situation to Mr Chikosi, and I handled that situation in exactly the same way as Mr Chikosi, and I responded to the RCVS in exactly the same way as Mr Chikosi EXCEPT:

Instead of saying that I followed the Vets Now SOP slavishly because I thought that it was required by my employer, I say, truthfully, in response to the RCVS enquiry, that I made a professional judgement that the guidance given in the SOP was the best way and the most ethical way of dealing with the professional dilemma that I faced, and therefore chose to follow the SOP after considering and rejecting other possible solutions as being "less good".

Do I still get struck off?

[/quote] maybe - if they decide that means you "showed no insight into your actons" ;)