Campaign to restore Chikosi

Re: Campaign to restore Chikosi

Jo Dyer — Mon, 02 Jun 2014 08:09:04 GMT

[quote user="Malcolm Ness"]

I retain my concerns that the pressure that needs to be put on the College in general and DC in particular is going to be diluted by aspects of what might, in future, become known as the Chikosi circus - a noisy side-show that will detract from the main event.

[/quote]

I absolutely agree, and hope this does not turn out to be the case.

Re: Campaign to restore Chikosi

Malcolm Ness — Sun, 01 Jun 2014 21:22:32 GMT

[quote user="Jo Dyer"]I have read the transcript of the hearing (which is freely available on request from RCVS) in its 63-page entirety[/quote]

I think you are misinterpreting this. PIC and DC are, I believe, kept quite separate. The bit you quote is just the legalese pre-amble for the members of DC.

[quote user="Jo Dyer"] He had no previous concerns against him [/quote]

It was your word "concerns" that drew me - I was aware that Chikosi had never been as far as DC before but I am told that some vets "have their card marked" because, perhaps, they have a more than average number of complaints against them and I wondered if your comments might be giving weight to that rumour.

Re: Campaign to restore Chikosi

Jo Dyer — Sun, 01 Jun 2014 19:51:01 GMT

[quote user="Malcolm Ness"]

[quote user="Jo Dyer"](the RCVS's own legal assessor's advice should have been taken at this stage).[/quote]

What was the College's legal assessor's advice at that stage and how do you have access to that information?

[/quote]

I have read the transcript of the hearing (which is freely available on request from RCVS) in its 63-page entirety. I really must get out more. At the end of Day One (page 53) the legal assessor says 'The Committee should be reminded that the College cannot prove that a respondent has failed to meet the standard by establishing that another veterinary surgeon would have done something differently. It has to show that no reasonably competent veterinary surgeon in general practice, providing an out-of-hours service, would have done what the respondent is alleged to have done'.

It also says 'no inference should be taken against Mr Chikosi by reason of his failure to attend the hearing today'.

[quote user="Malcolm Ness"]

[quote user="Jo Dyer"] He had no previous concerns against him [/quote]

I have no reason to doubt this but again, you seem privy to information that I would have thought should be confidential.

[/quote]

Day 2 page 2 - Ms Curtis, of Counsel, instructed by Penningtons solicitors; 'I confirm that there are no previous findings against this respondent of the Disciplinary Committee.'

Re: Campaign to restore Chikosi

Malcolm Ness — Sun, 01 Jun 2014 16:47:11 GMT

[quote user="Jo Dyer"](the RCVS's own legal assessor's advice should have been taken at this stage).[/quote]

What was the College's legal assessor's advice at that stage and how do you have access to that information?

[quote user="Jo Dyer"] whether Mr C is a good vet or a bad vet, a nice chap or a b**tard. Those things are irrelevant.[/quote]

Agree absolutely and not just because it is near impossible come up with workable, objective definitions of a "good vet" and a "bad vet"

[quote user="Jo Dyer"] He had no previous concerns against him [/quote]

I have no reason to doubt this but again, you seem privy to information that I would have thought should be confidential.

[quote user="Jo Dyer"]The implication in Vet Times[/quote]

Better to stick with the facts, I think.

[quote user="Jo Dyer"] to bring it in line with the rest of the world[/quote]

Unhelpful hyperbole. Only a minority of countries have a recognisably self-governing veterinary profession so coming in line with the rest of the world would most likely have us somewhere between government technocrat and animal health technician.

[quote user="Jo Dyer"]The knock-on effect of this decision is that good, responsible vets are potentially putting themselves in physical and mental danger because they are scared of becoming involved in a disciplinary process.[/quote]

Undoubtedly so, but a lot of the "knocking on" has happened outside the disciplinary process and has not always been desperately well-informed. The current disciplinary process and is held in very low regard by a large part of the profession. The major ongoing problem, as I see it, is the continuing refusal (or at least failure) of the President and others to engage with the members and explain what happened with Chikosi and DC; why it happened; what is being done to make sure it doesn't happen again and finally, and much the most important, the President should be explaining to those of us in practice where the lines actually lie as far as visits etc etc.

Re: Campaign to restore Chikosi

Jo Dyer — Sun, 01 Jun 2014 11:39:27 GMT

In view of the available facts of the disciplinary case, the decision was wrong on many levels and should never have got past PIC (the RCVS's own legal assessor's advice should have been taken at this stage). I have no idea whether Mr C is a good vet or a bad vet, a nice chap or a b**tard. Those things are irrelevant. He had no previous concerns against him and even in the worst case scenario made a single mistake (as decided by people not working at the coalface) for which IMO he should have been given advice and signed off. The knock-on effect of this decision is that good, responsible vets are potentially putting themselves in physical and mental danger because they are scared of becoming involved in a disciplinary process.

The implication in Vet Times is that Mr C is coming back to the UK to grovel, apologise to the owners and brush up on his CPD, in the same way that Mr Baird had to before him. If he were to do this it would entirely undermine efforts to change the Guidance to the CPC to bring it in line with the rest of the world; changes which are needed in order to protect the safety of our fellow professionals.

I would be surprised if this was the case with David Bailey being involved. However, with the lack of clarity currently prevailing, I will not be contributing.

Re: Campaign to restore Chikosi

Bob Russell — Sat, 31 May 2014 12:13:29 GMT

[quote user="Anthony Todd"]

[quote user="Bob Russell"]Almost all my sympathy for Mr Chikosi is exhausted! [/quote]

The big test of Mr Chikosi will be his response to the massive effort made by lots of folk to right his perceived wrong.

Let's hope he rewards all our efforts by acting appropriately.

[/quote]

There are two distinct issues here IMO.

1) The DC's behaviour and comments - very worrying to many of us that it suggests a lack of realism and professionalism. Quite depressing to see the blankets, biting indicating unnecessary suffering stuff!

2) Mr Chikosi failing (and still failing it would seem) to provide any explanation (unless this is happening behind the scenes) for his actions.

Justice needs to be done and seen to be done!

I have no idea if justice was done as there is only one side of the case presented. More worrying for a professional person trying to work in an ethical way, justice was absolutely not seen to be done (at least to me).

Any of us could put a reasoned defence for this sort of action (arguably right or wrong in hindsight) even if we accept that it was a mistake on reflection. If we had continued to work (albeit outside the UK) and could show reasonable efforts to keep up with CPD etc then I fail to see why a prolonged stay in the UK would be required prior to applying to be re-instated.

Not sure how he is going to get round the visa obstacle as a struck off vet as he is unlikely to qualify as a student!

I would much prefer to support Mr Chikosi as the underdog fighting a system that has let us down but the DC was given a free reign because no defence was offered.

Hopefully Mr Chikosi is dealing directly with the RCVS and DC, offering reasons for his behaviour that night and in the aftermath. Then it is up to the DC to demonstrate it can be fair, grown up and professional in its response. This will do more to restore confidence that anything else that I can think of.

Re: Campaign to restore Chikosi

Anthony Todd — Sat, 31 May 2014 10:15:33 GMT

[quote user="Martin Atkinson"]So now I have a VW Polo, a SEAT Ibiza or the nurse's FIAT 500[/quote]

Have you sold your bike [after all you're getting on a bit]?

Re: Campaign to restore Chikosi

Anthony Todd — Sat, 31 May 2014 10:13:49 GMT

[quote user="Bob Russell"]Almost all my sympathy for Mr Chikosi is exhausted! [/quote]

The big test of Mr Chikosi will be his response to the massive effort made by lots of folk to right his perceived wrong.

Let's hope he rewards all our efforts by acting appropriately.

Re: Campaign to restore Chikosi

Martin Atkinson — Fri, 30 May 2014 18:31:12 GMT

[quote user="Bob Russell"]Almost all my sympathy for Mr Chikosi is exhausted! [/quote]Hear, hear. Has anyone actually asked him if he really could be bothered coming back to the UK. I wouldn't be surprised if he stuck up the middle finger to the lot of it.

PS I sold my estate car/ambulance last month on the understanding that my new car was about to be delivered. The dealer then informed that whoops they'd made a mistake and it wan't coming to mid July. This means I have only small cars: a VW Polo or SEAT Ibiza or the nurse's FIAT 500 to use. Will I be guilty of a Chikosi style offence if I say, 'sorry, no I can't transport your 60 kg dog that is off its legs back to the surgery'. Or should the car dealer be culpable and be struck off for failing to deliver on his promise?

Re: Campaign to restore Chikosi

Bob Russell — Fri, 30 May 2014 13:20:22 GMT

At the risk of igniting the same old circular arguments!

Apparently Mr Chikosi will need to be housed and fed while he undertakes CPD and the process is going to be 6 to 12 months according to Veterinary Times!

Why? Is he really that out of date?

Almost all my sympathy for Mr Chikosi is exhausted!

Re: Campaign to restore Chikosi

Richard Stephenson — Mon, 28 Apr 2014 23:56:49 GMT

[quote user="glen mcintosh"]So a claim for Judicial Review by the Administrative Court of an RCVS DC decision cannot be made by other interested parties (other than the complainant or respondent)?[/quote]

Cases dealt with below the DC level are treated as confidential so only the parties would know of the decision and thus only they could seek a JR. It is an interesting point as I guess a consumer group or campaign group could try to challenge the RCVS processes in a class action - but I think that's getting a bit far fetched.

[quote user="glen mcintosh"]

[quote user="Richard Stephenson"]The RCVS has no right to appeal a decision (unlike the GMC or GDC for example).[/quote]

That is interesting. Why is that? Had that option been available, do you think the RCVS would/should have exercised it for the Chikosi decision?

[/quote]

Usually when regulators appeal the decision of the respective disciplinary tribunal it is because they think the tribunal has been too lenient - I can only think of one case (the nurse who was struck off for whistle blowing to the TV and then reinstated on appeal) where a regulator has suggested a sanction was too harsh. The VSA 1966 was obviously pre the Shipman Report so the concept of no double jeopardy was considered more important than the public interest. In other medical regulators the public interest is now considered so important that the traditional double jeopardy rules no longer apply i.e. if you are a Doctor the GMC panel may dismiss the charges against you, but you can still find yourself in danger of conviction on Appeal to the High Court. I think this is something those who advocate a new VSA should keep in mind - its not a route I would recommend! So in short it would be extraordinarily unusual for any regulator to appeal against a tribunal finding effectively in support of the charges made.

Yours,

Richard S.

Re: Campaign to restore Chikosi

Jo Dyer — Mon, 28 Apr 2014 20:27:23 GMT

[quote user="glen macintosh"] [quote user="Richard Stephenson"](1)...The problem is that no one, is actually suggesting that you do remove the obligation altogether (as far as I know) and in that context its hard to see how the current advice can change a great deal.[/quote]

What about the nearly 3000 signatories of Jo Dyer's petition that requests exactly that? [/quote]

I understood Richard's quote to refer to the 24-7 obligation, not OOH domiciliary visits, but I stand to be corrected. The petition requests the removal of the obligation to perform visits and that the decision whether or not to visit is left entirely to the individual vet.

[quote user="Richard Stephenson"]The RCVS should formalise the current situation and permit practices to opt out of providing this service [OOH domiciliary visits] providing always that a veterinary surgeon will be available to see an animal, in an emergency, at a suitably located veterinary premises and the following conditions are complied with:-[/quote]

As far as I can see, Richard and the petitioners are in complete agreement, surprisingly!

Re: Campaign to restore Chikosi

Glen McIntosh — Mon, 28 Apr 2014 19:48:24 GMT

Thanks Richard,

That is very helpful.

[quote user="Richard Stephenson"]If a complaint is closed prior to a DC hearing the complainant can seek judicial review[/quote]

So a claim for Judicial Review by the Administrative Court of an RCVS DC decision cannot be made by other interested parties (other than the complainant or respondent)?

[quote user="Richard Stephenson"]The RCVS has no right to appeal a decision (unlike the GMC or GDC for example).[/quote]

That is interesting. Why is that? Had that option been available, do you think the RCVS would/should have exercised it for the Chikosi decision?

[quote user="Richard Stephenson"]I was suggesting that they come here partly because the regulatory environment has enabled a healthy profession (up to now) which of course results in all the benefits (such as higher wages) you correctly list.[/quote]

Yes, I think that is true.

Re: Campaign to restore Chikosi

sandpiper — Mon, 28 Apr 2014 19:43:08 GMT

Glen, +1 to your entire post, but particularly -

[quote user="glen mcintosh"]

These charges are unique in the history of the RCVS DC, and take an almost philosophical approach to interpretation of the Code, unlike any other set of charges that have come before the DC.

It is as if the RCVS was trying to enforce its own version of the Animal Welfare Act, only in a much more draconian way than would ever be enforced in the real world, and with a penalty that is disproportionately excessive.

[/quote]

and

[quote user="glen mcintosh"]By the way Richard, I think your submission to the Standards Committee (overall but particularly with respect to your Conclusions: Domiciliary Visits Small Animals) is excellent, and an approach that I would whole-heartedly support.[/quote]

Re: Campaign to restore Chikosi

Anthony Todd — Mon, 28 Apr 2014 19:36:56 GMT

"But we do need to appreciate that very rarely that is simply not possible or in the animals best interests."

"there will always be the impaled cat, the giant breed that has collapsed etc."

I think this is a convenient reason to presume that a visit is always mandatory.

Cats' getting themselves caught in fan belts or impaled is not common and of course they have to be visited, in fact, I could say that the only occasion where a visit is essential is when the animal literally cannot be moved as in the case of the impaled cat or trapped by a fan belt

The vast majority of genuine emergencies should involve the sort of equipment and care only available at a veterinary surgery or OOH centre.

This will happen quicker, again in almost all cases, provided the owner is given instruction.

Although there will be some pain involved, which could be avoided by analgesia on site, that must be balanced against the advantages of good light, good equipment, and good staff at a veterinary centre.

The sooner this concept is encouraged and broadcast the better for animal welfare.

Re: Campaign to restore Chikosi

Richard Stephenson — Mon, 28 Apr 2014 19:26:01 GMT

[quote user="glen mcintosh"]

[quote user="Richard Stephenson"](1)...The problem is that no one, is actually suggesting that you do remove the obligation altogether (as far as I know) and in that context its hard to see how the current advice can change a great deal.[/quote]

What about the nearly 3000 signatories of Jo Dyer's petition that requests exactly that?

[/quote]

Sorry - so many points in your email missed this one!

I didn't think that Jo was suggesting that - but in point of fact I have suggested a means by which it could be done.

it is a very difficult issue there will always be the impaled cat, the giant breed that has collapsed etc.

Yours,

Richard S.

Re: Campaign to restore Chikosi

Richard Stephenson — Mon, 28 Apr 2014 19:16:36 GMT

[quote user="glen mcintosh"]Richard, I would be interested if you could confirm that the Judicial Review option was available at any point and, if it was, why did not the RCVS publish the availability of this option?[/quote]

Dear Glen,

Anyone suspended or removed by the DC has 28 days in which to lodge an appeal The Appeal route (laid down in the 1966 Act) is to the Judicial committee of the Privy Council (effectively the same as the Supreme Court (formerly House of Lords)). {Interestingly the 1948 made the High Court the appeal body}. Mr C did not avail himself of his rights in this respect (Unlike Mr Samuel more recently). After the 28 days the decision is final, cannot be challenged and comes into force. Usually an Appeal takes about one year and the respondent can continue to practice until Their Lordships hand down Judgement (which has to be personally endorsed by the Queen - believe it or not!). After 10 months the respondent has an automatic right to seek a restoration hearing but we need to be VERY clear that is not the same thing as an Appeal. Restoration hearings are listed within two months of being received.

The RCVS has no right to appeal a decision (unlike the GMC or GDC for example).

If a complaint is closed prior to a DC hearing the complainant can seek judicial review (this is in fact very rare) - presumably respondent vets wouldn't usually dispute closure of a complaint but in theory at least they could seek a judicial review.

Does the RCVS inform respondents regarding the appeal process? It is my understanding that this would be included in the written notice of decision sent by the Registrar to the Respondent giving the 28 days notice of removal (or suspension). In this particular case it was certainly mentioned on the RCVS web site - as the reason the Board couldn't comment immediately on the 'blanket ban'. It is also in the DC guidance notes made available on the web site.

Regarding your other comments I would add that I wasn't trying to say that other countries deal with OOH in the same way we do - rather that our investigation showed that contrary to popular opinion vets in most other countries do have some form of ethical / regulatory obligation to provide OOH. That varies and I gave the example of Norway where the State underwrites the system. I do sometimes see statements like 'we are the only country that does this' which is not the case.

Also I wasn't for a minute suggesting that European Graduates come to work here because of our 24/7 OOH obligation - I was suggesting that they come here partly because the regulatory environment has enabled a healthy profession (up to now) which of course results in all the benefits (such as higher wages) you correctly list. I see it as part of the 'level playing field' as I hope by 24 / 7 WP submission more eloquently expounds.

Glad you I've written something that others agree with!

Yours,

Richard S.

Re: Campaign to restore Chikosi

Glen McIntosh — Mon, 28 Apr 2014 18:30:14 GMT

What about the nearly 3000 signatories of Jo Dyer's petition that requests exactly that?

[quote user="Richard Stephenson"](2) I don't agree that the RCVS is the only veterinary regulator to require OOH provision, for example the New Zealand Council has an almost identically worded code:-[/quote]

Yes, it requires an OOH provision, but it is silent as to a requirement to attend a domicillary visit, at least by my reading. Very much unlike the RCVS.

I'll wager that no practicing New Zealand small animal vet feels any obligation from their governing body, to perform house visits, under any circumstances.

I would wager that the situation is identical, in New Zealand, to that in the USA and Australia, where no such obligation to perform house visits exist, under any circumstances, yet where, as Sandpiper points out, small animal veterinary standards are AT LEAST as high as those of the UK, where public demand for a high standard of veterinary care for pets is AT LEAST as high as that of the UK, and where public and veterinary concern for animal welfare is AT LEAST as high as that of the UK.

[quote user="Richard Stephenson"] (3) The RCVS contacted numerous main land European Regulators and effectively every one had similar provisions to our code[/quote]

I simply do not believe it. They may have similar provisions with regard to house visits (but I sincerely doubt it - please sent us the internet link to these provisions that you quote and google translate can do the rest), but I do not believe that any vet in mainland Europe feels the weight of this obligation in terms of their professional livelihood like many vets practicing in the UK.

[quote user="Richard Stephenson"](4) It is one of those urban myths that we are the ONLY country that struggles with this issue - but even if we were I have to say that the High Standards expected by the UK profession seem (up to this time) have created a veterinary environment which around 600 - 800 Foreign (European) graduates wish to work in ever year - so perhaps we've hitherto got something right?[/quote]

Please ask those 600-800 foreign graduates what they think of the obligation to perform house visits that exists in the RCVS Code (which has been rammed home to all practicing vets not just by the Chikosi decision, but also by the Albring and Baird decisions) and I think you might be surprised.

I think most foreign graduates that come to the UK would quote any number of other reasons other than any particular part or even the whole of the RCVS code for wanting to work as veterinarians in the UK - namely better pay, better working conditions, more jobs etc. The RCVS and its code plays very little role in these reasons, which exist mostly due to the UK economy, but also, undeniably, the greater willingness of the British public to spend money on their pets in comparison to most mainland Europeans, and the high uptake of pet insurance.

[quote user="Richard Stephenson"]I certainly agree that the best place for cats and dogs to be seen in an emergency is at the clinic - no one disputes that. But we do need to appreciate that very rarely that is simply not possible or in the animals best interests.[/quote]

Absolutely.

But RCVS DC decisions like Chikosi just scare the sh1t out of everybody. Say what you like about the guy, but he did not delay the visit because he was drunk or on drugs, he was not asleep, and he delayed the visit for good reason (at least in my opinion and that of many others - even if he says it was because he was afraid of getting in trouble with is employers).

And what is more, he actually performed the visit and did so within 1 and a half hours of receiving the call.

Yet he was still struck off.

There is no doubt that better decisions could have been made that night that would have shortened the time period between the call and the house visit, but then again, I would wager that all of us practicing veterinarians could have made better decisions at more than one time in our careers that would have shortened an animal's suffering by at least 30-40 mins (in some cases days).

If what some people on this forum have implied about Chikosi's criminal liability under the animal welfare act were true (which, of course, it isn't), and we are all to be honest, then very few practicing UK veterinarians would not have been convicted at some point in their careers.

And while I have every sympathy for both Mitzi and her owner following the events of that night, I think that it is a uniquely British and somewhat perverse phenomenon that the owner should complain about the time it took for the house visit to be performed, and that the veterinary governing body would take that complaint seriously. In any other country, a house visit would not have been performed, the dog would have been transported to the nearest veterinary clinic by the owner with the assistance of professional advice on how to move the animal by telephone, (including the use of a blanket). There would be no complaint, in all likelihood the attending veterinarian at the clinic would have been thanked for being ON SITE so as to attend to the animal so promptly.

The more I think about this case, the more I am amazed, not only by the DC's crazy decision, but also by the charges created by the PIC (who, I presume, write the charges):

a) unreasonably delayed attending to Mitzi; and.or

b) caused or allowed Mitzi to remain in pain and/or suffering for longer than was reasonably necessary;

AND THAT in relation to the facts alleged, you have been guilty of disgraceful conduct in a professional respect.

These charges are unique in the history of the RCVS DC, and take an almost philosophical approach to interpretation of the Code, unlike any other set of charges that have come before the DC.

The DC, however, is (or should be) the final safety net for both the public and members of the RCVS (although, fortunately it seems, but not in the Chikosi case, there is always the Privy council) and it should have identified the dubiousness of the charges, even in the absence of a defendant.

The members of the DC are duty bound to apply their expertise to the issues (as per the Disciplinary Committee Manual):

"Can the member use his own expertise or specialist knowledge?

92. It has been said many times by the courts that the professional members of a disciplinary tribunal may and should use their own expertise in deciding on the issues before them. This is particularly relevant when considering clinical issues and the standards adopted by the profession."

And this is essential where there is no expert testimony provided (from either side in the Chikosi case). Alas, no members of the Chikosi DC had had any experience of small animal out of hours practice or small animal domiciliary visits within the last 15 years, and hence had no expertise on which to call upon. The result was that the DC failed in its duty to provide justice, not only to the complainant (and general public as a whole) but also to the defendant (and all of the members of the RCVS).

Many people have said that the Chikosi case does not really matter to most "honorable vets", because they would be safe because they would provide an explanation for their actions, just like Mr Chikosi would have been safe, had he provided an explanation.

But he didn't provide an explanation, so we really don't know if he (or the greater body of "honorable vets") would have been protected against these pseudo-philosophical charges.

And many people say that the Chikosi case does not set a precedent. Well maybe not in the strict judicial sense of stare decisis, but future DC's are obliged to maintain consistency in their decision making, (as per the Disciplinary Committee Manual):

"Consistency in decision making

94. Consistency of approach in the way cases are dealt with is important. If a Respondent is dealt with in a markedly different way from another who committed much the same offence, then there is likely to be an appearance of unfairness and a sense of grievance on the part of the Respondent."

The problem is, this was a bad decision based on flawed charges made by members whose expertise lay in fields other than that at issue.

It is indeed a great shame that Mr Chikosi has only now decided to become directly involved with the case. A request for restoration is the only option available to him, and I wish him all the best, however even if he is successful it will do nothing to clarify the situation for the rest of the profession.

There has been mention of Judicial review as a potential option for review of the Chikosi DC decision. I understand that this may have been an excellent option, given that Mr Chikosi did not appeal the decision, that could have been exercised by any number of interested parties (eg BVA, VDS, Vets Now), since it does not require the initial respondent (Mr Chikosi) to be party to the action. Unfortunately, as I understand it, the window for this process has also closed, the deadline being 3 months after the initial decision. The following link provides more information:

http://vetjuris.blogspot.hk/2013/09/much-has-been-written-over-past-few.html

Richard, I would be interested if you could confirm that the Judicial Review option was available at any point and, if it was, why did not the RCVS publish the availability of this option?

I am in agreement with others in that I don't think that Mr Chikosi needs my financial assistance to obtain restoration (but I could be wrong about that, and I would like to hear his side of the story, even if it is via the Vet Times), but I would gladly support (and lobby the professional representative bodies to support) an option such as judicial review - for the good of all members of the profession, if such an option were available. Unfortunately I don't think it is.

By the way Richard, I think your submission to the Standards Committee (overall but particularly with respect to your Conclusions: Domiciliary Visits Small Animals) is excellent, and an approach that I would whole-heartedly support.

Re: Campaign to restore Chikosi

Hannah Wynne Richards — Mon, 28 Apr 2014 17:19:23 GMT

There are an awful lot of elderly people who are not "media savvy" - and who would be unable to video, and then e mail to the practice.

Wynne

Re: Campaign to restore Chikosi

Anthony Todd — Mon, 28 Apr 2014 17:10:48 GMT

[quote user="Gillian Mostyn"]orry - post ended up longer than intended! What I was trying to say was that the system all rests on our willingness to explain our actions. Without that, there can never be a satisfactory resolution. I am baffled as to why either Mr Bailey or Mr Chikosi cannot simply explain here why no defence was offered. [/quote]

I'm rather looking forward to the next "visit delay DC hearing"as you have just demonstrated owners will get to a vet. if it is explained to them that treatment given will be quicker and better.

BUT there must be a script agreed, or at least available, for the receptionist to be able to instruct the owner as to how to transport the animal and so far no suggestions....

Ree the Chikosi affair:

Once we know the timeline and communication trail we will be able to give a really informed opinion as to whether Mr Chikosi and/or the DC should have done more and better.

It would be so easy for the DC to publish it and show just how well the correspondence trail was handled, or not.

For instance if the DC said something like "we will contact you again if...." and for 6 months he heard nothing then I think, if he had pressing personal matters any reasonable person or even a reasonable vet.[!] would have assumed the matter had been dropped and attend to other pressing matters

The DC has been strangely silent on the timeline and correspondence which doesn't reassure me that Mr Chikosi is as feckless as has been made out; maybe so but more evidence would help assuage the suspicion I feel [Richard, see, I didn't say many...]

Re: Campaign to restore Chikosi

Richard Stephenson — Mon, 28 Apr 2014 16:51:17 GMT

Dear Sandpiper,

My understanding is that submissions to working parties become 'public documents' and as a condition of submitting a paper thereto is that you are happy for others to read it. So I've copied it below.

Yours,

Richard S.

Issues surrounding OOH cover – particularly domiciliary visits.

Summary.

From the 2008 survey we know that 24 / 7 enjoys the overwhelming (66%, if one adds options 1 & 2 together 84%) support of the membership. 80% of our membership said they would vote to keep it. It is not, however required by law or by charter and is granted as a privilege to the public due to the commitment and dedication of the profession. In doing so the profession is currently exceeding the norm for other professional groups within the UK.
Limited changes may be required in the interests of preserving the status quo given that 85% of vets feel they are being asked to do more than other comparable professions. In particular the issue of how ‘clients’ should be defined and to what extent an obligation to provide emergency OOH cover to non - clients needs reconsideration.
OOH domiciliary visits in SA practice no longer command the support of the profession and practices should be permitted to opt out subject to specific conditions (see below). However there needs to be clear guidance on how far it is reasonable to expect clients to travel to an OOH centre. Can an emergency clinic in Coventry reasonably cover for a practice in Bristol?
Clients should be required to choose and register with a practice - if there is to be a professional obligation to provide emergency care to their animals. The terms of such registration should be for local negotiation.
Clients who fail to register would need to source veterinary cover when required but that would be a matter of free negotiation between vet and potential client not a matter of professional conduct.
The practice of patient ‘ping pong’ needs to be carefully examined and appropriate advice given and enforced.

What has changed?

Even since 2008 there has been an unremitting shift in small animal practice to large scale corporate ownership, frequently in ‘lock up premises’ and this expansion has been largely enabled by out sourcing of OOH cover. This has enabled large numbers of start-up practices. The ‘new’ system of veterinary practice has without doubt offered improvement in working conditions to practitioners who have by and large been freed from the grinding responsibility of ‘being on call’. It is not as clear that either animal welfare or the public interest has been as well served. The ‘new’ system is generally a far more expensive one (OOH clinics having to cover their entire costs from OOH work alone), there is no patient care continuity, and disturbing examples of patient ‘ping pong’.

The breaking point currently seems to be the Code of conduct requirement for practices to make provision for domiciliary visits at all times if required on welfare grounds. Whereas one vet on call covering for his / her own practice might well have been available to do a home visit, one vet covering for 20 or more practices is placed under considerably more pressure by requests for visits. Further emergency clinics may well be covering for very large geographic areas (too large?)

Further the profession has encouraged a ‘shop around’ approach to the vet / client relationship. Special offers on neutering, vaccinations and wormers for example are regularly used to encourage client mobility. It is thus not surprising that clients may use one practice for cut price vaccination, another for neutering, whilst buying drugs from internet pharmacies. The concept of a professional relationship between vet and client involving life time care to the client’s animals has to an alarming extent been willfully destroyed in the scramble to win new clients.

In my opinion the RCVS urgently needs to try and re-establish a proper professional relationship between clients and vets by encouraging a general registration scheme via the Code of Conduct.

Many members of the profession now work as employees of large national corporations and may have no direct relationship with their employers. There seems to be some contention that as employees their first duty is to follow the instructions, working practices of their employers even if these are in conflict with the Code of Practice. Professional people are always placed in a difficult ethical position if employers or powerful clients pressurised them to act outside the Code. Unfortunately that goes with the territory of being a professional. The RCVS has no remit to regulate corporate employers but it should always be willing to support members who ‘whistle blow’ regarding poor management practices and encourage them to do so. The College must however be firm in maintaining the need for professional people to accept full professional responsibility for all their actions.

General Observations.

In the extensive 2008 survey of opinion within the profession 80% felt that removal of the 24 / 7 rule would damage the image of the profession in the public eye – a statement with which I wholeheartedly agree.
There was however a clear warning that attitudes within the profession could easily change in the answer to Qu 50. The overwhelming majority 85% (96% in Scotland) feel that we are asking more of vets than any other comparable profession. This is very understandable in the light of recent changes to the GP service within the NHS. It suggests to me that the RCVS needs to carefully foster support for 24 / 7 and where necessary make minor concessions with a view to the bigger picture of retaining a vital veterinary service.
Home visits in small animal practice. 66% of respondents opposed the current position of the RCVS in this respect (only 29% supported the then GPC provision) – it is the only area in which we do not enjoy strong support from our members. Worse still is the fact that 17% of S.A. practices openly admitted to having a no visit policy. If the earlier survey conducted by the Vet Review also reflects current practise then it must be accepted that in reality many S.A. practices routinely refuse OOH domiciliary visits (although they presumably do them in normal hours). Further where visits are theoretically at least offered the fee demanded can be very high (figures of between £400 - £600 are not infrequently seen in complaints from the public) I would hold that the current position is becoming untenable. The current CoC rules are simply unworkable for many dedicated OOH providers unless in addition to having a duty vet dealing with cases at the OOH centre they also have further on call back up to do visits. Few of the commercial OOH service providers have a formal back up system – seemingly relying on the goodwill of off duty staff to fill in. Duty staff have to phone around a list of potential veterinary surgeons and hope that one is available and prepared to attend. This in itself can build in excessive delay in attending potentially genuine cases.
Opting out of 24 / 7. It has long been a worry of mine that permitting individual practices to ‘opt out’ would result in a rash of ‘cherry picking’, start up, one man practices. To some extent my ‘worry’ has now become reality. This must be of some concern given that the overall veterinary market (small animal) is contracting. There must be an economic limit to the number of practices that can compete on the basis of undercutting prices for basic services and there has already been one major bankruptcy in the sector (VPI). It cannot be in the public interest to create an environment in which competitive pressures could result in a decreased standard of care. As a regulator we have a responsibility to ensure healthy competition on a level playing field. 73% of those surveyed (correctly) identified that permitting opt outs would cause an unfairness in the market – however it seems to me that it is inevitable that we will be forced to do so at least in respect of domiciliary visits.
The practice of performing sometimes complex and involved surgery or medical procedures in what are effectively ‘lock up’ shops with the intention of either discharging the animal to its owner’s care immediately after or ‘ping ponging’ the animal to an OOH provider needs careful consideration. Should this even be contemplated let alone occur in 21^st C veterinary medicine? Should major abdominal and orthopaedic surgery only be performed in practices with the capability to provide the necessary aftercare – the answer seems obvious to me. Does the RCVS need to give clearer and firmer guidance on this.

Conclusions.

Domiciliary Visits Small Animals.

OOH domiciliary visits to small animals. The RCVS should formalise the current situation and permit practices to opt out of providing this service providing always that a veterinary surgeon will be available to see an animal, in an emergency, at a suitably located veterinary premises and the following conditions are complied with:-

a) Practices opting out of OOH domiciliary visits must make this clear on all practice advertisements, literature and invoices. The RCVS should be notified and an appropriate entry made in the Register of Veterinary Premises. It must also be pointed out that neighbouring practices that do provide this service to their own clients cannot be expected to respond to calls from clients who have chosen a non – visiting practice. They may, of course, wish to do so both for ethical and commercial reasons.

b) Practices that are wholly ambulatory must provide their normal service at all times or arrange a similar ambulatory cover with another mobile provider.

c) Confirmation from the practice’s professional liability insurer that they are happy with a no OOH visiting policy.

d) The PSS inspectorate to be responsible for ensuring that the above are complied with and that practices opting out agree to cover the costs of any inspections.

Having made this concession I would expect failure to meet the provisions of the CoC to be rigorously investigated by both the PIC and DC.

Contractual arrangements.

I have long believed that a more professional relationship between veterinary surgeon and client should be encouraged by requiring clients to register with a veterinary practice if they wish to avail themselves of an OOH emergency service for their animals. The AWA 2006 places the onus on the owner or keeper of an animal to take reasonable steps to ensure its welfare. Question 62 suggest that this is, as yet, a minority view with only 44% support (only 9% of respondents do this at present) – although only 18% were aware that it is currently permissible to charge a registration fee. I still think that long term this would be a sensible way of promoting responsible pet / animal ownership as well as providing a potential income stream for hard pressed practices.

Richard Stephenson

Dec 2014

Potential for conflict of interest.

1 I am a partner in a small animal and equine practice that is actively involved in the provision of 24 / 7 emergency care. We provide OOH emergency cover to 5 other practices in the locality.

2 I am an elected member of RCVS Council, a current member of the PIC and a former member of the DC.

3 My election manifesto for the RCVS council (2008) made the following pledge concerning 24 / 7 emergency care:-

Our commitment to 24 hour care is a core value and should not be watered down; but I accept that the question of providing home visits to small animals out of hours needs reassessing and the Guide to Professional Conduct brought into line with majority practice.

Re: Campaign to restore Chikosi

Jo Dyer — Mon, 28 Apr 2014 15:19:21 GMT

[quote user="Richard Stephenson"]It is one of those urban myths that we are the ONLY country that struggles with this issue [/quote]

Sandpiper was referring to house visits OOH, not OOH cover generally. I don't know of any vets who think our 24-7 commitment should be dropped, although there undoubtedly are some. I thought the former was an urban myth as well until I researched it, and I still can't find any other country where you feel obliged to do some visits out of fear of disciplinary action. A friend of mine works for an OOH provider in NZ and certainly does not have this obligation (he says the system would not work if they did).

Thank you for sending me your submissions to the 2009 and 2014 reviews of 24-7, Richard, I was indeed quite surprised! I am not going to quote from private correspondence, but I see from your published (undated) Veterinary Practice article, which I presume is ok to quote, a proposal that;

'Emergency care should not compulsorily include domiciliary visits (for small animals) unless specifically agreed in advance in the ‘care agreement’'.

The whole article was eminently sensible, I am in full agreement, and I very much hope the rest of RCVS Council can be persuaded to agree with you

Re: Campaign to restore Chikosi

sandpiper — Mon, 28 Apr 2014 14:42:31 GMT

Thank you Richard, comprehensive and informative, as always.

I was referring to the home visit element rather than 24/7 provision. To my knowledge, no one has gone anywhere near suggesting removal of a 24/7 provision.

It will be very interesting indeed to see the outcome of the 24/7 consultation. I am doubtful that any significant change will result - most specifically re the home visit requirement - but as you point out, time will tell.

By the way, are you able to post a link to your own submission to the 24/7 consultation, that you mentioned sometime back on this thread?

Re: Campaign to restore Chikosi

Richard Stephenson — Mon, 28 Apr 2014 14:29:07 GMT

[quote user="sandpiper"]While the home visit requirement is often ascribed to the high standards of care certainly present here, the lack of the house visit requirement in any other country and the apparent blank refusal to consider its removal [/quote]

(1) the RCVS Standards Committee is currently reviewing the 24/7 requirements including the Home Visit advice note - where does 'apparent refusal to consider its removal' come from? I understand that there have already been 3 days of evidence gathering select committee style and the committee is meeting again for several days to try to reach a recommendation for Council to consider. The problem is that no one, is actually suggesting that you do remove the obligation altogether (as far as I know) and in that context its hard to see how the current advice can change a great deal. I do think it an unfair criticism to imply a 'refusal to consider' when great lengths are being gone to, to do exactly that!

(2) I don't agree that the RCVS is the only veterinary regulator to require OOH provision, for example the New Zealand Council has an almost identically worded code:-

Veterinarians in clinical practice must make an emergency service available at all times. This service is required so that their clients’ animals can receive essential veterinary treatment in order to relieve unreasonable or unnecessary pain or distress.

The emergency service must be sufficiently resourced, so that except in extraordinary circumstances all veterinary emergencies involving clients' animals are attended in reasonable time to ensure the welfare of the animals. A decision of what is a reasonable time will take into account the type of practice and the locality.

Those veterinarians on duty and directly responsible for providing the emergency service can refer callers who are not clients to the emergency service provided by the caller's own veterinarian. However, if that alternative service is not available and if the veterinarian has the necessary skills and resources required for the particular emergency, the veterinarian must attend the emergency and provide essential treatment.

(3) The RCVS contacted numerous main land European Regulators and effectively every one had similar provisions to our code - although the means of delivery varied enormously (for example in Norway the government compensates vets who attend OOH and don't get paid!)

(4) It is one of those urban myths that we are the ONLY country that struggles with this issue - but even if we were I have to say that the High Standards expected by the UK profession seem (up to this time) have created a veterinary environment which around 600 - 800 Foreign (European) graduates wish to work in ever year - so perhaps we've hitherto got something right?

I certainly agree that the best place for cats and dogs to be seen in an emergency is at the clinic - no one disputes that. But we do need to appreciate that very rarely that is simply not possible or in the animals best interests.

Yours,

Richard S.

Re: Campaign to restore Chikosi

Gillian Mostyn — Mon, 28 Apr 2014 14:09:20 GMT

[quote user="Anthony Todd"]Possibly, but more to the idea that treatment at the OOH centre will be quicker and better and the owners expect to have to do just that.[/quote]

Anthony - this is where we completely agree. I am not, and have never, beenof the opinion that visits should be 'the norm'. I agree entirely that all owners should take responsibility for their own pets and visits be necessary only when the condition of the animal warrants it.

However, this case, and the subsequent furore, seems to have given the impression that the RCVS expectations have changed. Pet owners NEVER have the final say and fear of a complaint should NEVER be the reason to carry out a home visit. That is why Chikosi needed to engage with the complaint and why I feel no sympathy with him now; if he had, we wouldn't be having this discussion. The decision on his complaint, which was that he delayed unnecessarily, seems to have had the 'chinese whispers' treatment and has now become about whether home visits are ever necessary, which is odd when everyone agrees that sometimes (rarely) they are!

I suppose actions speak louder than words. We had a 'textbook' case a couple of weeks ago. Lady rang in middle of busy morning surgery demanding an immediate home visit for her cat - apparently had a broken leg, screaming in agony... etc etc.... When told 'no', she would have to bring the cat in, she became abusive and aggressive with the receptionist. Was offered different resolutions:

-immediate appointment at the clinic - she didn't drive and her mum was in middle of chemo for her cancer so couldn't bring her either

-taxi numbers (no - apparently didn't have enough money for a taxi)

-put cat in basket and carry it round- she was approx 10mins walk away. Apparently she had no basket or appropriate box.

-asking friends and relatives - simply said no

The lady was very nasty- all the usual abuse (we only care about money etc etc) and threatened to 'report us'. My assistant vet was wavering (fear of complaint), but it was me that was adamant that a visit was simply not required.

The lady eventually appeared at the practice, cat in box, 24hrs later. The cat was approx 2/10 lame and had an abscess on one of its forelimbs.

She may complain, she may not. I really don't care either way. We all make, and have to stand by, decisions all day every day. I don't see this decision different to any other I made that day. Hindsight means that sometimes our decisions are wrong - it is simply part of the job - and as long as we can justify and defend what we have done, and the decision was a reasonable one, then there is nothing to fear!

Sorry - post ended up longer than intended! What I was trying to say was that the system all rests on our willingness to explain our actions. Without that, there can never be a satisfactory resolution. I am baffled as to why either Mr Bailey or Mr Chikosi cannot simply explain here why no defence was offered.