Feeling rubbish about a case...

RE: Feeling rubbish about a case...

Anthony Todd — Sat, 02 Jun 2018 12:35:24 GMT

[quote user="Rob Davis"]The rather odd comment[/quote] etc.

No it isn't. It is important though, because it was obviously possible to link a vet's colour ethnicity or nationality to a DC verdict which is baloney, of course, as was the verdict and the ridiculous advice re "blankets"!

RE: Feeling rubbish about a case...

Rob Davis — Sat, 02 Jun 2018 11:31:01 GMT

Hasn't all this Chikosi stuff been done ad nauseam previously? The rather odd comment which triggered this discussion has not been explained and may be nothing to do with Chikosi...

I'm not sure any of it is useful to the OP.

RE: Feeling rubbish about a case...

Anthony Todd — Sat, 02 Jun 2018 11:10:04 GMT

Perhaps some agreed policy of transporting injured animals to a place where adequate emergency care can be given ie a vet clinic, would eliminate most of the concerns and provide the best care in the future?

Speed, facilities, methods, additional advice??

Or it will happen again!!

RE: Feeling rubbish about a case...

Glen McIntosh — Fri, 01 Jun 2018 22:43:11 GMT

[quote user="Gillian Mostyn"]In the absence of any defence, he is removed from the register.[/quote]

This is interesting.

He doesn't need to provide a defence, does he? The onus is on the RCVS to prove their case, not for him to prove his innocence. That is the presumption of innocence, the golden thread that runs through the British justice system.

So, even in his absence, even if no defence is proffered, the RCVS can still legitimately find the charges proved and strike him off. The RCVS decision should have nothing to do with whether he responds to the charges or not.

Or they can legitimately find the charges not proved, whether he is there or not, or whether he responds to the charges or not, based on the witnesses and evidence presented by the college alone.

It is, of course, a disciplinary offence not to respond to requests for information from the RCVS, including complaints enquiries. You may well get struck off for that.

I don't think you would have heard a peep from anybody had Chikosi been struck off for failure to respond to legitimate enquiries from the college regarding this complaint (at least until such a time as he did chose to respond to the complaint).

But he wasn't struck off for that, he was struck off, essentially, for taking too long to attend a house visit because he waited until the emergency clinic (probably the only one in a catchment radius of 20 - 30km) of which he was in sole charge was appropriately covered by another vet. The RCVS says (and still says, because the decision still stands) that this was serious professional misconduct (or disgraceful conduct in a professional sense), and of such gravity that he should be permanently removed from the register.

It was this decision that resulted in gobsmacked vets around the world, in campaigns to try and help Chikosi (successful or not), in various RCVS enquiries, changes to to the code and retractions about statements about blankets etc. The outcry was simply because an overwhelming number of vets thought the decision ridiculous and outrageous.

The article highlighted by Tony is well worth a read:

https://www.vettimes.co.uk/nay-nay-and-thrice-nay/

The final statement in this 2014 article correctly predicts that "...we will still be talking about it years from now."

[quote user="Gillian Mostyn"]They cannot reassure the client that the vet cared at all. [/quote]

This is not what the RCVS complaints process, and certainly not the DC process, is about at all. It is there to determine whether the actions of a vet amount to serious professional misconduct, or not, and if so to determine the appropriate sanction.

RE: Feeling rubbish about a case...

Gillian Mostyn — Fri, 01 Jun 2018 20:41:18 GMT

[quote user="Evelyn Barbour-Hill"]No, once he got another veterinary surgeon to the emergency centre, he went straight out to PTS the dog.[/quote]

Fair enough. I thought it was the other vet who went.

RE: Feeling rubbish about a case...

Evelyn Barbour-Hill — Fri, 01 Jun 2018 18:40:25 GMT

OK. My last comment on the matter.[quote user="Gillian Mostyn"]their vet repeatedly refused to attend[/quote] No he didn't. He said it was not possible to attend until he got another veterinary surgeon to attend the emergency centre where he was supposed to be. [quote user="Gillian Mostyn"]and then another vet did attend and PTS the dog.[/quote]. No, once he got another veterinary surgeon to the emergency centre, he went straight out to PTS the dog.

RE: Feeling rubbish about a case...

Richard Carter — Fri, 01 Jun 2018 18:37:53 GMT

except that if you happen to be of African descent, you have already had to wade against a tide of residual buttered side always down from officialdom even in this so called enlightened age. I didn't believe this was still the case until I was the passenger with a Zimbabwean vet who was driving in UK, we innocently passed some traffic police and he said at the time - we will be stopped - and we were. Just a licence check Sir!!

so for Mr Chikosi to believe he was being hung out to dry and there was very little point in putting himself through the ordeal, I can completely sympathise.

One of my actions when I become God-Emperor will be to instruct the RCVS to re-instate him to correct a miscarriage of justice where an impossible situation had been placed on someone unable to comply with the request. We seem to think it quite ok for NHS to leave patients for hours to days waiting for ambulances, sitting on trolleys etc so have a one strike policy and you are out is ridiculous.

RE: Feeling rubbish about a case...

Anthony Todd — Fri, 01 Jun 2018 18:36:29 GMT

[quote user="Gillian Mostyn"]OK...my last comment on the matter...[/quote]

And mine too.

Seems strange then, that there was this massive reaction by practising vets to this case when the facts, apparently, were so indefensible, even to the extent of funding his air fare back to the UK???

RE: Feeling rubbish about a case...

Gillian Mostyn — Fri, 01 Jun 2018 18:00:15 GMT

OK...my last comment on the matter...

The RCVS received a complaint from a client. Their dog was badly squashed by a tractor, it bit the owner when he attempted to move it, their vet repeatedly refused to attend and then another vet did attend and PTS the dog. The client felt that their vet simply didn't care about their dog and it's undeniable suffering.

The RCVS then investigate, including getting both sides of the story, so that hopefully they can reassure the client that the vet did, indeed, care...but his circumstances dictated his actions. Unfortunately the vet doesn't respond to the complaint. At all. They cannot reassure the client that the vet cared at all. In the absence of any defence, he is removed from the register. It simply isn't possible for the RCVS to make up a defence for him, when the nurse on site confirmed that he wasn't otherwise occupied.

As far as not receiving any paperwork at all and having no knowledge whatsoever about the case...does anyone really believe this?

RE: Feeling rubbish about a case...

bevs2251 — Fri, 01 Jun 2018 06:20:42 GMT

An On - you did well. Don't stress. Animals die no matter how hard we try.

As to the Chikosi case, I think us antipodean vets were horrified with the outcome. I know I was. We are very sensitive here in Australia to being hauled up before our respective Veterinary Practitioners' Boards for the slightest infraction. To hear that a vet manning an after-hours centre by himself with just one nurse and no back up, doing the best that he could; to then be called out to do a house-call euthanasia on his own when there was no-one else available to take over the emergency clinic, and then to be struck off for his efforts was just gob-smacking !! Doesn't matter the ethnicity - incredibly unfair and uncalled for to be struck off like that.

I understand that he did not respond in his defence, but there was also a question as to whether he actually received any correspondence. At the very least, the case should have been left open-ended until further information was supplied.

RE: Feeling rubbish about a case...

Anthony Todd — Fri, 01 Jun 2018 01:16:44 GMT

[quote user="David Mills"]

Whatever hapoened to that Irish vets campaign for Chikosi to return? I think he posted on here.

[/quote]

Yes there was, such was the disquiet but he did not and didn't respond well, it must be said.

and see below.

[quote user="Gillian Mostyn"]Not accurate. He declined to reply to any questions or correspondence at all, at any stage. If he had replied, it is very likely the case would never have even got to DC.[/quote]

Sorry, he did not appear, but had returned to Zimbabwe well before the DC hearing, I stand corrected.

[There was a lot of "discussion" at the time as to whether the DC'c documents had even been sent "recorded delivery" too.]

Such was the feeling at the time that a support fund was begun to help fund his return to the UK but he did not return.

However, just search "Chikosi vet", read the wide ranging comments by vets and others, and see if you think his appearance would have made any difference at all.

https://www.vettimes.co.uk/nay-nay-and-thrice-nay/

http://www.forensicvet.com/media/uploads/Chikosi.pdf are just two of many.

I don't think there has ever been a more criticised decision of the DC, mainly of the infamous "blanket", and I would be surprised if his appearance would have made any difference at all.

RE: Feeling rubbish about a case...

David Mills — Fri, 01 Jun 2018 01:10:40 GMT

Whatever hapoened to that Irish vets campaign for Chikosi to return? I think he posted on here.

RE: Feeling rubbish about a case...

Anthony Todd — Fri, 01 Jun 2018 00:20:16 GMT

Sorry, he did not appear but returned to Zimbabwe before the DC hearing, I stand corrected.

However, just search "Chikosi vet", read the wide ranging comments by vets and others, and see if you think his appearance would have made any difference at all.

https://www.vettimes.co.uk/nay-nay-and-thrice-nay/ is just one of many.

I don't think there has ever been a more criticised decision of the DC, and I would be surprised if his appearance would have made any difference at all.

RE: Feeling rubbish about a case...

Gillian Mostyn — Thu, 31 May 2018 20:28:51 GMT

[quote user="Anthony Todd"]He then returned to Africa, but declined to return for further appearances before the DC when there was such a protest at the way he had been treated.[/quote]

Not accurate. He declined to reply to any questions or correspondence at all, at any stage. If he had replied, it is very likely the case would never have even got to DC.

RE: Feeling rubbish about a case...

Evelyn Barbour-Hill — Thu, 31 May 2018 20:15:42 GMT

[quote user="Jill Butterworth"]BIPS are no good for this (or for anything in my opinion!)[/quote]

I disagree. BIPS are extremely useful.

RE: Feeling rubbish about a case...

Anthony Todd — Thu, 31 May 2018 18:45:28 GMT

[quote user="Adebowale Ajao DVM, PGCertSAM, MRCVS"]Would you please do well to enlighten us about this statement of yours? I am only curious as I am African (now british citizen). I know my breed is rare in the vet profession but will be grateful if you can shed more light on what you mean. Thanking you in advance[/quote]

This is a veiled reference to a vet from Kenya Mr Chikosi, who was well and truly stitched up by the DC and his employer, when he failed to attend an injured animal late at night.

He then returned to Africa, but declined to return for further appearances before the DC when there was such a protest at the way he had been treated.

Led to a real rethink and assessment of the actions, expertise and competence of the DC in future which was particularly embarrassed by the denigration of a blanket as a temporary stretcher for a badly injured animal, as it appeared obvious that the member of the DC had probably never had to manage an injured animal in his life.

RE: Feeling rubbish about a case...

Martin Atkinson — Thu, 31 May 2018 11:21:10 GMT

Perhaps gdbvet would like to enlighten us as to why he/she feels this way, maybe something that has happened personally related to their own ethnicity. From their profile, I see he/she is based in the Antipodes maybe the system works differently there?. Otherwise I can see it could just be a silly throwaway remark which he/she may now realise was injudicious. We all say things we shouldn't sometimes but its not a wise idea on a public forum.

RE: Feeling rubbish about a case...

Cool — Thu, 31 May 2018 11:16:53 GMT

[quote user="gdbvet"]

Good thing you're not African or Eastern European.Would probably be the end of your career.

[/quote]

Would you please do well to enlighten us about this statement of yours? I am only curious as I am African (now british citizen). I know my breed is rare in the vet profession but will be grateful if you can shed more light on what you mean. Thanking you in advance

RE: Feeling rubbish about a case...

Cool — Thu, 31 May 2018 11:14:11 GMT

[quote user="An On MRCVS"]

Thank you for all the replies and support. It helps to know that many people would have not done anything a lot different.

I completely take on board Antony's view that sometimes an ex-lap early on can tell you everything you need to know. I did seriously consider opening the dog up as soon as it didn't respond to analgesia as I expected, and I think this is partly why I feel so bad - because if I had followed my gut instinct then I would have pushed the owners for this more. But I was worried that if I was wrong and it was spinal, and i started doing surgery on it for the abdomen, I didn't want to make the spine worse by having the dog moved about while UGA (I have heard of cases of making the disc move more when all the muscles are so relaxed), and the owners didn't want to go for surgery given that I wasn't absolutely certain it was indicated. But I just worry I should have pushed them for ex-lap harder at an early stage... But as some of you say, it may have made no overall difference to the outcome and I guess I'll never know the answers to 'what ifs'

But I do feel a little better that many of you don't say that you think I missed a very obvious diagnosis early on.

To be fair to my colleagues, I did send a couple of them a photo of the x-ray and asked for opinion and spoke to one of them in the evening before I went to ex-lap, so they didn't leave me completely on my own. But it was a busy day, and it probably doesn't help that I got about 4 hours sleep on the Saturday night, and then after the ex-lap and time spent trying to revive the dog, I didn't get home until 5am on Monday morning, so lack of sleep will not have helped my emotions either I guess!

I guess the main thing, as you say, is that I will learn from this and it may help patients in the future.

I am not 100% sure even now what caused the perforation - the area was very thickened and reactive, so my main differentials are a random ulcer (although do they happen in the intestines? I thought they were mainly stomach where the acid levels are greater) or neoplasia.

Thank you very much for all the input, advice and kind words. Starting to feel a little better about it but it still sucks so much and I think it will stick with me for a while.

[/quote]

You did really well An On and I cant see any negatives in what you have done. Sometimes some decisions are not that easy to make and I will suggest you dont beat yourself up at all. A decision had to be made at the time and you did your best. You diagnosed the problem and went ahead to correct the anomaly. it is unfortunate the dog died. I dont think anyone would have done any better within the confines of the limitations of your working condition. That is what is called experience. Well done. You are a great vet.

RE: Feeling rubbish about a case...

Clive Ansell — Thu, 31 May 2018 10:30:20 GMT

[quote user="gdbvet"]Good thing you're not African or Eastern European.Would probably be the end of your career.[/quote]

Why?

I can see no issues whatsoever in how this case was managed, and would probably have done similar myself.

Regardless of the Anon's ethnicity, why should it affect their career in any way?

RE: Feeling rubbish about a case...

Bob Russell — Thu, 31 May 2018 10:16:29 GMT

[quote user="Julie Innes"]

[quote user="gdbvet"]Good thing you're not African or Eastern European.Would probably be the end of your career.[/quote]

That's a pretty unpleasant statement. What makes you so sure anon is NOT African or Eastern European?

[/quote]

Tend to agree this is unpleasant. Also foolish!

Chikosi (presumably the 'African' association) refused to communicate with the PIC/DC. If he had I suspect he might have faced the 'better communication next time' communication.

I don't know of any instance where the DC has intervened because someone was Eastern European. One lied about performing an operation done by a colleague (disastrous dog castration if I remember correctly).

If you have any information to suggest there is racism within the Royal College then of course it must be addressed. I can think of a few things I disapprove of at the Royal College but racism or sexism does not appear on the list.

RE: Feeling rubbish about a case...

Nicola Cole — Thu, 31 May 2018 10:02:18 GMT

I had one a couple of years back that was very difficult to distinguish between abdo and spinal pain. Slightly sketchy on some of the details I remember but came in quiet and inappetant. Reacted on direct abdo and spinal palpation and stiff on neck movement. No proprioceptive deficits etc. Can’t remember bloods but think were pretty much normal. Initially treated with methadone, cerenia. Did screening abdo rads (not suggestive of FB) and spinal rads-conformational abnormalities on shape of many vertebrae but difficult to know if relevant d/t breed (Boston Terrier).

My ‘gut‘ feeling was GI. However, couldn’t rule out neuro inc whether brewing meningitis-style. Spoke to referral centre-no temp and no deficits so advised to cont as were for moment. Following morning mild ataxia. Owners opted for referral (owners very concerned) but with warning that still think GI. Had MRI-no functional abnormalities, neck pain and mild ataxia likely due to abdo pain (can’t remember if had vomited but certainly not ongoing) causing mild increase in CSF pressure. Recovered uneventfully over next 24-48hours.

RE: Feeling rubbish about a case...

Richard Carter — Thu, 31 May 2018 09:37:55 GMT

[quote user="gdbvet"]Good thing you're not African or Eastern European.Would probably be the end of your career.[/quote]thought it was male, over 50 and working alone that killed you off the register

Just a comment re abdominal surgery - have also delayed and then lost the patient on the table so now I am much more prepared to open up and look if - xrays/ ultrasound inconclusive, GI stasis, severe pain esp not responding to buprenorphine/ methadone; age - young active known to eat things etc

In humans the time to start panicking is when the appendicitis which has been painful suddenly stops being painful - peritonitis about to follow!!

RE: Feeling rubbish about a case...

Julie Innes — Thu, 31 May 2018 08:55:29 GMT

[quote user="gdbvet"]Good thing you're not African or Eastern European.Would probably be the end of your career.[/quote]

That's a pretty unpleasant statement. What makes you so sure anon is NOT African or Eastern European?

RE: Feeling rubbish about a case...

gdbvet — Thu, 31 May 2018 08:53:31 GMT

Good thing you're not African or Eastern European.Would probably be the end of your career.