Complaints transparency

RE: Complaints transparency

grumpyoldman — Sun, 02 Apr 2017 11:34:13 GMT

[quote user="Malcolm Ness"]This is not friendly advice that is being given out, it is a sanction and is delivered as such: it is recorded on 'your record' and can be used by the College, for example to reassure a disgruntled client that a vet has been given a good telling off.[/quote]

If its closed its closed , End of. The thought police leaving comments about an "alleged attitude" after an event or interaction they were not a party to, and after dismissing the complaint itself as nonsense, is extremely unfair. The only way forward now is CCTV in every consult. Leaving unproven advice on someones record could be a problem if they chose to live and work abroad and for example asked for a letter of good standing and the "recent advice" was forwarded with it?. If its not going to be forwarded in those circumstances what is the point of doing it other than placating the wrath of the silly client.

RE: Complaints transparency

Malcolm Ness — Sat, 01 Apr 2017 07:31:08 GMT

[quote user="Richard Stephenson"] advising a proper protocol to avoid future complaints of a similar nature is entirely according to the known and undisputed facts. [/quote]

That, in my experience is absolutely untrue.

The PIC has expanded its role to what Arlo eloquently describes as a "Lower Court" but at the same time the essential processes that ensure the defendant has a right to see the charge made against them and defend it are missing. While the initial 'concerns' always relate to possible SPMC (if they didn't, like a speeding fine they are not a matter for RCVS) what Richard indicates is that PIC has assumed a right to trawl through the paperwork provided for the first defence and infer, even construct secondary offences which they then judge and award sanctions as they and they alone see fit without further involvement of the defendant. That flies in the face of a basic part of UK law - innocence until guilt is proven.

Having seen a couple of cases in considerable detail - including one against me for which I have obtained the internal College email correspondence - I have seen evidence that some members of PIC lack impartiality and objectivity. The claims of expertise are overblown.

This is not friendly advice that is being given out, it is a sanction and is delivered as such: it is recorded on 'your record' and can be used by the College, for example to reassure a disgruntled client that a vet has been given a good telling off. [quote user="Richard Stephenson"]

Unfortunately I guess that the more conscientious vets probably take 'advice' as being criticism or negative, or even upsetting perhaps forgetting that the word CLOSED precedes it.[/quote]

If the word "Closed" preceded it then it was closed, and if PIC or anybody else thinks that there is any other 'concern' then it behoves them to raise that concern anew and follow due process remembering innocence until proven guilty - proven in the legal sense and that is very definitely not merely the shared opinion of members of PIC.

RE: Complaints transparency

Michael Woodhouse — Sat, 01 Apr 2017 00:24:59 GMT

[quote user="Richard Stephenson"]One of the oddest things about the RCVS process is the number of times that PRACTICES have advised clients to complain about them to the RCVS (presumably on VDS advice??). This is generally because the practices concerned have got sick and tired of dealing with the complainant. Surely there must be a better way than members advising clients to complaint about them to the regulator[/quote]

This is an interesting one, I've suggested it a couple of times to people when it's turned into a stupid back and forth exchange of correspondence getting nowhere. The most recent case involved a rabbit the owner had been 'treating' homeopathically. She didn't like paying for the real drugs used to euthanase the rabbit or the emergency appointment. I was polite and factual (and ran my letters past the VDS) but I was keen to point out the errors in her thinking (especially when she was going to give the rabbit some shaken water to make it comfortable over the weekend). In the end I suggested if she really wasn't happy with our treatment then she could contact RCVS.

She didn't. Really I would only say it when I didn't think we'd have done anything wrong and I have faith in the regulator that would be the outcome. I really don't know the solution to such people, but if you want to wind up a homeopath pointing out the legality of lay treatment under the VSA and calling people selling homeopathic remedies 'fraudulent' is very effective.

RE: Complaints transparency

Richard Stephenson — Fri, 31 Mar 2017 23:56:22 GMT

OK Arlo since its you I'll break a rule of a lifetime and contradict mYself by having a second last word largely because I think it has dawned on me where the conceptual problem lies for you (and it would appear others).

This thread is in the context of complaints that the PIC has CLOSED ie found that their is no SPMC or that iT is not in the public interest to proceed to a DC hearing.

That is a conclusive finding in favour of the respondent vet. The complaint is CONCLUDED (in the modern terminology).

As I have tried to point out use of emotive terminology such as innocence, guilt or sanction is NOTapplicable or helpful. The PIC deals with CIVIL matters so equivalence with the criminal courts is confusing (of course criminal conviction can become a master of professional concern such as sexual abuse of animals).

Where a case is Closed that is the end of the matter, advice given is aimed solely at preventing recurrence of the situation of receiving another complaint.

For example in the common case I have cited as an illustration regarding unlicensed drug use the way to prevent complaints is very simple - get a written consent form signed.

in closing said complaint (as an illustration only) the PICwould have found in favour of the vet with regards to SPMC however advising a proper protocol to avoid future complaints of a similar nature is entirely according to the known and undisputed facts. There has been a complaint, there is no evident to refute it, and we are left with an unnecessary 'he said she said situation'. I think Arlo that you are forgetting that the RCVS must always act in the public interest (of course vets are members of the public too) it would be negligent of its public duty if the professional regulator did not at least try to assist members in reducing their complaints statitics.

The only possible alternative in the first scenario i gave, would be a full DC hearing to test the facts, two witnesses say vet did not get consent vet says he did. Unknown outcome - but surely at best disproportionate to the nature of the case as described.

the PIC are the experts in conduct matters, whilst the DC are the ultimate arbitrators. Where members don't agree with CLOSING their case with advice (in fact so rare as to be limited to a tiny percentage of cases) they do have the option of seeking review. More often the public don't agree that CLOSING their complaint is correct and seek review and progression of the case. I would struggle to remember more than a handful off cases where vets have asked for review of a CLOSED case because of advice given, but it does happen - which suggests to me that 98% of the time people are at least content (if not happy).

There is of course a further scenario in which the PIC HOLDS OPEN a complaint but that a whole new discussion thread.

In short CLOSED or CONCLUDED complaints (concerns) are exactly that. In that context advice is exactly what it says - Advice.

Unfortunately I guess that the more conscientious vets probably take 'advice' as being criticism or negative, or even upsetting perhaps forgetting that the word CLOSED precedes it.

Anyway it's not my job to defend the system - if members think its rubbish they need to suggest an alternative, stand for election and see if they can Do better. My advice would be have great care what you wish for - any replacement is likely to be MUCH harder on veterinary surgeons - just my opinion.

RE: Complaints transparency

grumpyoldman — Fri, 31 Mar 2017 23:35:40 GMT

Its the same situation as being at school in the 1970s. Everyone gets detention because that will punish the guilty as well as deter the innocent. And after torturing people with a 3-6 month wait admitting that there was never really a problem to answer would be honest but would also look sluggish inefficient and possibly dickensian. Far better then to scuff the rascals round the ear with a minor telling off and mutterings about being careful in future and "we do not expect to see you outside the headmasters office again".

RE: Complaints transparency

grumpyoldman — Fri, 31 Mar 2017 23:22:56 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Arlo Guthrie"]As I said earlier, if someone IS innocent of the complaint made against them, but PIC thinks otherwise and gives advice then at the very least, advice sends the message that the regulator has it on record that you're in the wrong. That strikes me is a sanction. A blot on the vet's copybook.[/quote]

Exactly so.

And it would appear, from certain DC reports that have come out from time to time, that if you dispute, and inform the PIC that you reject, their judgmental advice, then your rejection in that case is held against you, as an aggravating factor, in any subsequent case against you.

[/quote]

That is very true, if you reject the silly advice about communication skills, because the complainant is clearly unhinged and lying through their teeth, they (the PIC fool who wrote the original advice and the registrar), have a tantrum.

RE: Complaints transparency

Evelyn Barbour-Hill — Fri, 31 Mar 2017 17:49:59 GMT

Exactly so.

RE: Complaints transparency

Arlo Guthrie — Fri, 31 Mar 2017 09:12:16 GMT

[quote user="Richard Stephenson"]i think we have reached the point where this thread is starting to go around in circles and I really cannot add any more[/quote]

[quote user="Richard Stephenson"]IM AFRAID THATS MY VERY LAST WORD ON THE MATTER[/quote]

I sense some frustration with me, for which I am sorry. But I hope you know that the motive behind my questions is sound (ie I am not being deliberately obtuse, and the only point of discussions like these is if constructive ideas come from them). And I am genuinely grateful for the time you've given me here.

For the sake of clarity:

[quote user="Richard Stephenson"]i would ask you to think about the three scenarios I used to illustrate various difficulties with this area. presumably you think all three should have been referred to the DC as that is the logical extent of your argument and it is a perfectly valid perspective. [/quote]

No, I am absolutely not saying that all your examples should be referred to DC. I don't have the answer to what should be done with them.

What I AM saying is that the current system seems problematic. And I wonder whether it is a contributory factor in the fear and blame culture in the profession that everyone talks about.

Taking your first example:

[quote user="Richard Stephenson"]For example a common one is Vet uses an off licence drug to treat Fido. Fido subsequently dies. Client then examines data sheet and finds that the medicine was actually for use in another species. Client was not told this (or perhaps cannot remember) Vet didn't get signed consent but says they did tell client. Client and her friend who was there at the time are both emphatic that the drug was just handed over with instructions to give one tablet twice daily.

Fact - the dog's death had nothing to do with the drug IMO. Fact the Vet has broken the code of conduct (if we believe client's version). Should this be referred to the DC - there is a conflict of evidence and arguably an animal has died so potentially serious.[/quote]

Doesn't this (the bit I've underlined) highlight the problem? Who exactly is deciding it's a 'fact that the vet has broken the code of conduct' and that the client is to be believed?

From your posts, it would seem that the answer to this is at least two members of PIC who are trained. But are they sufficiently qualified and informed to be passing judgement on guilt or innocence (and I am sorry if those are unhelpful terms, but it's hard to think about: 'Fact the vet has broken the code of conduct' in any other way). Are the systems for challenging/testing that 'verdict' (and it is), sufficiently robust?

[quote user="Richard Stephenson"]i think it is bizarre to consider being given advice as to how to reduce your chances of being complained about as a sanction or punishment. I spend all day giving advice to clients and they seem happy to pay for it. The aim of the PIC is to try and avoid complaints occurring in the first place not to have to deal with the fallout afterwards.[/quote]

If PIC was just giving nice, helpful advice of the sort you give your clients, I would agree that it would be bizarre to consider it as a sanction or punishment.

But this is a completely different context. As I said earlier, if someone IS innocent of the complaint made against them, but PIC thinks otherwise and gives advice then at the very least, advice sends the message that the regulator has it on record that you're in the wrong. That strikes me is a sanction. A blot on the vet's copybook. A really difficult one for an innocent vet (remembering what high standards you by and large set for yourselves) to accept.

And what if, in the process of handling the complaint, the complainant is told of PIC's judgement-lite? That would be a sanction.

When all's said and done, I'll bet that the system works in the vast majority of cases. And I don't doubt for one nanosecond that you are right when you say:

[quote user="Richard Stephenson"]I never suspected that the PIC did anything other their best to strike the correct absolutely fair balance[/quote]

My point is just that it is inevitable that from time to time, there'll be a wrong call. Someone will end up with that note on their record they didn't deserve. They will feel aggrieved. They will talk. It's a small profession. That's disproportionately damaging to PIC and contributes to a climate of fear and distrust.

All I argue is that surely there is a case for giving some thought as to how the system could be improved to avoid this. Both by better communicating the work of PIC:

[quote user="Richard Stephenson"]I began this by pointing out I am no longer a member of RCVS Council and it has always disappointed me that with 42 members no one else seems to engage with discussion on these matters.[/quote]

Yeah, me too! But if not directly from members of PIC, then at least with regular press releases to the veterinary media about the work PIC is doing.

And by considering whether the system could in some way be made a little more transparent.

Richard, I don't expect a reply to any of this, but I do thank you very much for all the time you've already given me.

[quote user="Iain Richards"] I can think of you and two others who've done their best to humanise and explain the RCVS.[/quote]

Yes, I couldn't agree more, and always admired them greatly for it.

RE: Complaints transparency

Iain Richards — Thu, 30 Mar 2017 21:58:31 GMT

Thanks again Richard, I can think of you and two others who've done their best to humanise and explain the RCVS.

RE: Complaints transparency

Richard Stephenson — Thu, 30 Mar 2017 19:24:42 GMT

Arlo

i think we have reached the point where this thread is starting to go around in circles and I really cannot add any more

i would ask you to think about the three scenarios I used to illustrate various difficulties with this area. presumably you think all three should have been referred to the DC as that is the logical extent of your argument and it is a perfectly valid perspective. It is however a point of view that I disagree with and I believe that 98% of vets would much rather be subject to the lighter touch of the PIC.

i think it is bizarre to consider being given advice as to how to reduce your chances of being complained about as a sanction or punishment. I spend all day giving advice to clients and they seem happy to pay for it. The aim of the PIC is to try and avoid complaints occurring in the first place not to have to deal with the fallout afterwards.

it does not help to use terms such as guilt and innocence in this. I text. Professional misconduct fills a spectrum from excellent to serious misconduct. There is an enormous grey area in the middle. Yes we could have a system when every arguable case is sent for a full DC hearing - my view is that would require around four DCs sitting continuously year round and cause huge stress.

members of the PIC are THE trained independent experts in professional conduct appointed by the authority of Parliament to decide these matters I.e. Is there an arguable case of misconduct if so is it serious and if so is there sufficient evidence to prove so as to be sure and finally where does the public interest lie. Every case is considered by more than one person and every arguable case by at least half the PIC (until recently the whole committe). BOth respondents and complainants can ask for a decision to be reviewed and on occasion do.

I began this by pointing out I am no longer a member of RCVS Council and it has always disappointed me that with 42 members no one else seems to engage with discussion on these matters. I conclude by saying that having sat In on over 1000 cases I never suspected that the PIC did anything other their best to strike the correct absolutely fair balance and to dealt with some very aggressive and unpleasant people both from the public and I'm ashamed to say from the profession in a highly patient and caring way. it is not perfect but deserves much more support than it receives IMO

IM AFRAID THATS MY VERY LAST WORD ON THE MATTER

RE: Complaints transparency

J G Wray — Thu, 30 Mar 2017 18:07:04 GMT

[quote user="Richard Stephenson"]

I have observed that one issue for the RCVS is that when staff leave they tend to move to other 'bigger' regulators - I suspect that the size of the RCVS doesn't give a large enough career structure for staff to be able to advance internally as much as they would like - the same problem that many medium sized veterinary practices have(particularly with VNs).

But I guess you'd have to post your question on a legal discussion forum to see how lawyers perceive working for the regulators.

[/quote]

Reporting back.

I've spoken to the legal forum I sleep with, which is a bit like poking a grizzly with a stick on subjects like this and she says:

"Dead end job"

and of the barristers with practices based on this area of law:

"Self-serving"

She used to work for Penningtons, who are known to RCVS in one form or another, but I daren't ask her about them; I value the contents of my scrotum even at my age.

RE: Complaints transparency

Bob Russell — Thu, 30 Mar 2017 11:49:59 GMT

[quote user="grumpyoldman"]

[quote user="Bob Russell"]Are they trying to justify their actions when none is really needed or are they trying to get me into hot water?[/quote]

Sometimes there is just a lack of joined up thinking at the lab. Mast cells migrate to lesions as well as out of them and without doing the clone testing its apparently hard to tell which is which. The other problem we have had is that the grunt doing the lab prep cuts the mass up for sectioning and just sends the pathologist the tissue in question .the report then comes back with incomplete margins . We have had this several times with bowel masses after taking several CMS either side of the lesion. We have now taken to sending slither biopsies of margins to be sure. But it all adds to the costs.

The other grumbler i had recently was over the size of the incision post sarcoma removal. The path report said good margins ,and the client wondered why we could not have made a smaller hole in that case. Your never going to satisfy some people and the culture of appeasement which blames the vet for everything thats wrong due to poor communication skills is really not helping, and is encouraging a section of the public to get increasingly silly and unrealistic with their expectations. I am waiting for Surrey University to start doing DIRECTED cuddly touchy feely CPD.

[/quote]

My complaint does not relate to the pathology report nor the actual actions of the referral clinicians. I do resent the statements that excision is incomplete when all the evidence is that it is not!

What the heck are they actually telling the client? Really should be a tangent!

RE: Complaints transparency

Chris Milligan — Thu, 30 Mar 2017 11:44:28 GMT

[quote user="grumpyoldman"]Its ok to just not like someone and go elsewhere anymore?. Why clients dislike some vets is interesting.[/quote]

They looked at this extensively in the human field and found basically 10% of any doctor's given patients really can't stand them because of their face, the way they play with their pen, the clothes they wear, the pattern of their speech etc. etc.

Long story short - 10% of your clients really don't like you and there's nothing you can do about it

RE: Complaints transparency

Arlo Guthrie — Thu, 30 Mar 2017 11:30:14 GMT

[quote user="Richard Stephenson"]The issue here is that there are many complaints that DO have some basis, vets have broken the CoC and since the complainant has read the CoC and read RCVS advice notes on the RCVS web site they know that the vet is in contradiction to the Code.[/quote]

Richard, I hate to say it, but I do think this is a bigger concern than I first thought.

What you seem to be describing is looking more and more like a 'lower court'. I mean, PIC is making judgements on guilt or innocence. And it is delivering a sanction of sorts (if you agree that 'helpful advice' runs the risk of being perceived very differently, and perhaps even straying into actually being something very different).

Without talking about individual cases, doesn't this really hit the nail on the head:

[quote user="Judith Joyce"]Richard's comment frightens me. The use of the words "know" and "truth". There may be some evidence but no individual member of CEG or PIC or even DC for that matter can "know" the "truth". That is what is tested by the system, conducted in accordance with the constitution.[/quote]

I absolutely take your point about the difficulty dealing with cases that don't merit a full DC, and the importance of common sense. But it's very hard not to agree with Malcolm's point here, that:

[quote user="Malcolm Ness"]If the College wants to extend its reach to deal with lesser "concerns" than those which might amount to SPMC, then it needs to put in place a transparent, fair and effective system.[/quote]

Transparent seems the most important thing in that sentence. Fairness and effectiveness are a consequence of transparency.

RE: Complaints transparency

grumpyoldman — Thu, 30 Mar 2017 10:49:45 GMT

[quote user="Bob Russell"]Are they trying to justify their actions when none is really needed or are they trying to get me into hot water?[/quote]

RE: Complaints transparency

grumpyoldman — Thu, 30 Mar 2017 10:30:42 GMT

[quote user="Richard Stephenson"]It needs to be better understood that the purpose of taking statements is to learn the facts NOT build a case. In the majority of instances statements confirm the PICs view that a matter should be closed - they do however need evidence to close a case not just assumption.[/quote]

That is not true, I remember two nurses being interviewed on matters of fact ,and then also being asked about the vets Social life , family life , and any potential drug related or alcohol issues ,they were obviously trying to build a case. As things turned out the client just did not like him and had made up a pack of lies supported by an accomplice troll to wriggle out of paying the bill. Which is actually what most of it is all about most of the time. The GPC is so prissy and precise its very hard for most people to not stub their toe in some minor way several times a year. Its the old highway code analogy, not following it does not make someone a bad driver. You cannot control what someone on the other side of the road is going to do.

RE: Complaints transparency

Judith Joyce — Thu, 30 Mar 2017 10:25:37 GMT

Richard's comment frightens me. The use of the words "know" and "truth". There may be some evidence but no individual member of CEG or PIC or even DC for that matter can "know" the "truth". That is what is tested by the system, conducted in accordance with the constitution. The harm comes when an individual thinks they "know" the "truth" and acts in that way without questioning it for example by relaying their version of the "truth" to the complainant before it has been tested by the due process. In the rest of the legal system, the defendant is innocent until proven guilty - this is what cannot be said of RCVS system currently.

RE: Complaints transparency

Bob Russell — Thu, 30 Mar 2017 10:19:12 GMT

[quote user="Thomas Johnson"]

[quote user="Bob Russell"]

I have a patient that has been referred (at owners request) to a well known high TV profile centre because a mass turned out a bit unexpectedly to be a mast cell tumour. Scans etc were advised.

Everything was clear but it was decided (rightly??) to do a more radical excision. Sadly and very irritatingly the post op owners sheet stated that this surgery was for 'incomplete excision of a mast cell tumour'.

My pathology report indicated clear margins all round!

I suspect this may cause problems because the referral practice are pretty much suggesting we did a bad job. Will they never accept that excision may actually have been with clean margins?

Sometimes a little thought for other clinicians can help avoid sticky situations!

[/quote]

I agree that they should have communicated better with you, but perhaps despite the margins being clear on the histology report it was sensible to take wider margins due to the risk of skip metastases further from the original tumour. If it is the centre I am thinking of in a large town in Surrey then I would call them to discuss the case, I have always found them very approachable and happy to talk about cases.

[/quote]

I don't disagree at all about the further surgery. It was my recommendation anyway! The additional histopath following surgery supports initial total excision so good news!

I dislike the fact that the term 'incomplete' excision' has been used because it is easily (and probably has) been accepted by the client as 'inadequate surgery' and therefore we did a bad job.

Even with follow up clear pathology the covering letter states 'No evidence of residual mast cell disease was seen in the scar' and 'this is not an unusual finding and likely reflects the number of sections that can be examined or immunological control of the tumour following surgery'.

Are they trying to justify their actions when none is really needed or are they trying to get me into hot water?

Not supportive of the referring practice and very unlikely to encourage me to support them further.

RE: Complaints transparency

Malcolm Ness — Thu, 30 Mar 2017 09:23:33 GMT

[quote user="Richard Stephenson"]As I pointed out above the truth is that many many cases can arguably be said to contain 'misconduct' what is rarer is for it to be SERIOUS.[/quote]

It may well be that some cases contain what some, or all individuals on PIC define as "misconduct" but that is not their decision to make and if it were then there would be a process in place to allow the 'defendant' to respond to this new complaint. If PIC can make these decisions adequately, why do we bother with DC? It is essential to keep sight of the FACT that ours in an adversarial system of law and the FACT that the papers seen by PIC are given in response to a SPECIFIC concern written by a complainant that is shown to the 'defendant' that they may respond with a defence.

The unlicensed product thing is a good example - I know of a colleague who was criticised and warned by PIC about this very thing. PIC assumed that because the paperwork had not been seen by them, then it did not exist and that escalated (exclusively in their heads) to a failure to comply with prescribing law. My colleague was not the subject of the complaint for which the papers were supplied and the unlicensed product forms were in the files from which they could have been produced had anyone asked. "Communication" is another popular PIC target and again, I have seen examples where papers supplied explicitly for one purpose have been massively over-interpreted and an accusation of "misconduct" is made - in one example, a clinician was criticised over failing to communicate with a client that wasn't theirs about a procedure they didn't perform.

If the College wants to extend its reach to deal with lesser "concerns" than those which might amount to SPMC, then it needs to put in place a transparent, fair and effective system. In my opinion, there is a pressing need to do this, but it must be done properly.

The current arrogant oligarchy is dangerous and indefensible. I see it as a significant source of the fear about which Dr Tufnell talked at his inauguration.

RE: Complaints transparency

Iain Richards — Thu, 30 Mar 2017 07:56:10 GMT

Thanks again Richard. Some years ago I suggested that RCVS could do a newsletter in a similar form to that of the VDS. "Tales from the PIC". The format is there - change the details, embellish one or two points and you have a story to tell. The consent for licensed vs unlicensed being a good example. There's no breach confidentiality, just examples and guidance. IT would drake better reading than the DC reports and might have a more beneficial effect. I had offered it to RCVS in my capacity as SPVS editor. I know that you can't do anything, but there are those on the list who can ask

RE: Complaints transparency

Richard Stephenson — Wed, 29 Mar 2017 23:36:03 GMT

[quote user="Arlo Guthrie"]

And actually, thinking about it some more, there could be a fine line between 'giving advice' and 'meting judgement / penalty', and I wonder if empowering PIC to (effectively) tell people they have done something wrong is also fraught with various dangers.

It would seem to me to be 'safer' and more transparent if PIC did only 'what it says on the tin', ie decide whether something goes to DC.

[/quote]

Arlo,

The issue here is that there are many complaints that DO have some basis, vets have broken the CoC and since the complainant has read the CoC and read RCVS advice notes on the RCVS web site they know that the vet is in contradiction to the Code.

However taking every minor transgression to the DC would certainly clog up the system, cause hundreds of vets per year unnecessary stress and cost both the VDS and the RCVS around £10,000 per day for every hearing.

For example a common one is Vet uses an off licence drug to treat Fido. Fido subsequently dies. Client then examines data sheet and finds that the medicine was actually for use in another species. Client was not told this (or perhaps cannot remember) Vet didn't get signed consent but says they did tell client. Client and her friend who was there at the time are both emphatic that the drug was just handed over with instructions to give one tablet twice daily.

I emphasise I am merely using this as an illustration of the scenarios that are common - I am simplifying the facts and I don't want to start a debate on the cascade system PLEASE.

In my view even taken at its worst the vet has forgotten to get verbal consent and by failing to get written consent cannot defend his actions (written consent is NOT however a requirement only informed consent which can be verbal). However his actions are illegal and contrary to the CoC if when tested the evidence supports the client. Even if proved it is highly unlikely the DC would sanction an otherwise competent vet for one 'oversight'. Therefore I would expect the PIC to close the case - however it has to give advice (because closing this case is not an exoneration - the regulator could not possibly imply that breaking the law is acceptable). Thus I would close this with Advice along the lines of - improve practice protocols to ensure properly informed consent for use of unlicensed drugs.

Now you might say that it would be better for the DC to deal with this - but I think 99% of vets would far rather get some helpful advice which stops this happening again, than be put through the trauma of a DC hearing (which is the alternative). Also the complainant will feel their complaint has helped by improving future communications in the practice - although complainants are only told that advice has been given not what that advice was.

Another common but subtly different scenario is trying to spay a male cat. This comes up surprisingly regularly and to lay people seems so grossly wrong that it amounts to SPMC. IMO it is difficult and pointless to argue that it is not negligent BUT it is clearly that - negligence and NOT misconduct. Such cases are invariably closed but the RCVS can hardly say - its perfectly OK to try and spay male cats. It is not possible to 'exonerate' a VS who has tried to spay a male cat doing so simply makes you look ludicrous and convinces the public that the whole process is a whitewash (wouldn't you think that). So whilst its not SPMC its not very good either. Surely the best path is to give some helpful words such as - practice needs to improve its protocol to check the sex of cats prior to surgery and make sure its followed?

Another common situation is the vet who fails to reply to a complaint from a MOP for a 3 month period. The CoC 2.7 is clear 'promptly reply' (there is of course room to interpret the word 'prompt' but in most peoples books 3 months wouldn't be prompt).( I do see the irony of the RCVS giving itself 3 months to resolve the first stage of the process but it does respond to all complainants within 48 hours). So clearly vet has broken CoC - i.e. committed misconduct & actually damaging to the reputation of the profession - but is it so serious it requires a DC hearing. Turns out that vet usually is very good at dealing with such issues but kept putting dealing with this one off because colleagues were off sick, problems with email, and frankly simply put it to the back of his mind. Vet appreciates not good enough and is apologetic in his response to the PIC. Again IMO can adequately be dealt with by some friendly advice - make sure you have a proper protocol in place to respond to your clients concerns. Yes it can be closed - no need for anyone to be struck off, but could a responsible regulator just walk away and say that's fine nothing wrong has happened??

What I am saying is that in every day life from filling in tax returns, driving too fast, parking without a ticket, taking out a library book for too long, dropping litter we accept that there has to be some common sense applied. We don't prosecute people for trivial minor offences or genuine mistakes, they get a police caution or simply a few cross words from a police officer. No one wants the courts bogged down dealing with someone who dropped orange peel on the pavement. The same must be true for RCVS disciplinary matters. We have a completely independent group of people with no axes to grind who spend hours over exactly the types of scenarios I've given three illustrative examples of - do we really want people sent to the DC - a formal court - because they got dealing with a complaint wrong, were negligent or dispensed a drug outside the cascade?

As I pointed out above the truth is that many many cases can arguably be said to contain 'misconduct' what is rarer is for it to be SERIOUS.

RE: Complaints transparency

Richard Stephenson — Wed, 29 Mar 2017 22:22:51 GMT

[quote user="Anthony Todd"]

How many, at a guess, of concerns/complaints have their base in the cost of whatever was done or not done?

I'm thinking of "Cost a fortune, animal died, so I'm not paying and may get away with that if the vet is found "guilty" of something".

Seems it may be relevant in the "arbitration" suggestion floating around.

[/quote]

In my experience very few complainants SAY that they are dissatisfied with costs. I am not blind to the possibility that although they don't say it is the cost that is the issue that it might well be. However the various veterinary charities are not immune from having complaints so they cannot all be driven by finance issues.

In fairness to the British public I have to say that I saw complaints by people who had paid 5 figures sums for treatments which turned out badly and generally they were not complaining about the fee nor were they asking for a refund - balanced against that big fees come with big expectations with regards to levels of service and care so I would be reluctant to suggest there is no relationship!!!

RE: Complaints transparency

Anthony Todd — Wed, 29 Mar 2017 19:12:48 GMT

[quote user="Thomas Johnson"] 'incomplete excision of a mast cell tumour'.[/quote]

That's just histologists being smart-arsy in that they, and many histologists, could argue that you can never guarantee total removal of a mast cell tumor. ....

I'd ring them and tell them about the *hit you are now in and change histologists!

I remember a famous case where a circus lion died after an anaesthetic.

The pathologist gave his report and then added something like "I understand the lion was anaesthetised with drug X [forgotten the drug] this drug is contraindicated in cats" [or big cats].

Or a colleague of mine, asked to witness that a pedigree bull had a deviated penis and certified so and then added "this is inherited" when said bull came from the leading Jersey stud in the Waikato.... The **it that followed!

Expert opinions should be as concise and limited as possible!!

RE: Complaints transparency

Anthony Todd — Wed, 29 Mar 2017 19:01:22 GMT

[quote user="Evelyn Barbour-Hill"]I pointed out years ago that PIC had started to act like a sort of lower court.[/quote]

Yes but is that so bad?

Usually, in most acrimonious incidents, there are things the vet could do which would have avoided the whole affair; eg refusing to speak to the owner etc etc.

A bit of gentle anonymous advice will help members in the future;or not....

RE: Complaints transparency

Thomas Johnson — Wed, 29 Mar 2017 18:51:16 GMT

[quote user="Bob Russell"]

I have a patient that has been referred (at owners request) to a well known high TV profile centre because a mass turned out a bit unexpectedly to be a mast cell tumour. Scans etc were advised.

My pathology report indicated clear margins all round!

I suspect this may cause problems because the referral practice are pretty much suggesting we did a bad job.

Sometimes a little thought for other clinicians can help avoid sticky situations!

[/quote]