Is the veterinary profession heading this way?

RE: Is the veterinary profession heading this way?

Julie Innes — Wed, 29 Aug 2018 08:52:52 GMT

Maybe slightly off topic, but possibly relative to the GMC striking off etc, I received a letter from the RCVS last week. Always a bowel loosening moment, but they were writing to tell me about a complaint against me that they had resolved without my input! It was regarding a case where I assisted the SSPCA in seizing animals from a puppy farm. The owner was completely loopy- lying, hiding dogs, and she was found guilty at court, which she then appealed (despite already having previous convictions for animal cruelty, and there being very detailed and distressing photographs of the animals and the conditions)

She tried to get me and 2 other vets who testified struck off for perjury, and told some stunning lies in her letter of complaint, which the RCVS sent me a copy of, as well as their response, which gratifyingly defended us all strongly. I was pleased to see that the vet who reported the nutter to the SSPCA in the first place was also defended, saying that "our members must always put animal welfare as a priority over client confidentiality", as I believe they have always made this a grey area in the past!

So that was my first (and hopefully last!) experience of the RCVS disciplinary process and on this occasion I was pleasantly surprised, especially after hearing many terrible tales. So maybe our profession is getting a little better

RE: Is the veterinary profession heading this way?

Clive Ansell — Tue, 28 Aug 2018 17:51:48 GMT

It seems many doctors are now calling for the head of the GMC to stand down.

https://www.bbc.co.uk/news/uk-england-leicestershire-45328100

RE: Is the veterinary profession heading this way?

Evelyn Barbour-Hill — Tue, 28 Aug 2018 17:27:20 GMT

[quote user="Bob Russell"]makes sense to update. We can all benefit from a bit of retraining and supervision![/quote]

Which is exactly what she would have had, if she had not been shoved into a completely unexpected role to plug a gap in the staffing, the consultant meanwhile swanning off to do a bit of teaching.

RE: Is the veterinary profession heading this way?

Bob Russell — Tue, 28 Aug 2018 16:45:44 GMT

Not really!

She had been on maternity leave and as with any period off work it makes sense to update. We can all benefit from a bit of retraining and supervision!

RE: Is the veterinary profession heading this way?

Anthony Todd — Tue, 28 Aug 2018 16:24:13 GMT

[quote user="Bob Russell"]A period of 'retraining' and supervision would make sense to me.[/quote]

Provided it could clearly be shown that she was deficient in significant areas where she was directly responsible ie reacting to the key blood value, missing an obvious diagnostic feature etc. etc. and not just because of a series of holes in the swiss cheese that happened to line up.

I wish the Air Accident Investigation Branch [or the correct body] and not a bunch of Selfserving Sacrificers of Someone not Senior or Significant could be the deciding body!

The AAIB never seem to apply blame, just find out exactly what was the cause of the accident, considering all aspects which could be conceivably involved or have influence on the occurrence.

The blame, if any, comes later and separately, which is how it should be.

RE: Is the veterinary profession heading this way?

Bob Russell — Tue, 28 Aug 2018 11:32:30 GMT

She was clearly desperately upset with events both at the time and afterwards.

The person to strike off is the one that is unaffected by the event and therefore likely to repeat mistakes. Not heard the consultants side of the story so cannot judge whether he should receive more punishment. My guess is he should. Thankfully he is in Ireland so is very unlikely to treat my granddaughter!

A period of 'retraining' and supervision would make sense to me. The consultant should get a similar I cannot fathom out what made prosecution the correct thing to do except perhaps as part of a corporate manslaughter prosecution of the hospital management.

RE: Is the veterinary profession heading this way?

Iain Richards — Tue, 28 Aug 2018 08:29:14 GMT

She was sanctioned Michael, 12 month suspension, imposed by the fitness to practice committee. The GMC then decided to overrule this and remove her permanently.

There was the recent case of a vet who falsely signed certificates, 2 month suspension, because the vet had been in an abusive relationship and this affected their behaviour. A proportionate response.

RE: Is the veterinary profession heading this way?

Anthony Todd — Tue, 28 Aug 2018 04:53:29 GMT

[quote user="Evelyn Barbour-Hill"]You've got to be kidding.[/quote]

I think, on more reflection, the incident hinges solely on the blood lactate level and the reaction to it.

Read this:

https://acutecaretesting.org/en/articles/increased-blood-lactate-levels-a-marker-of

and this cherry picked

Therefore the presence of increased blood lactate levels should prompt the clinician to initiate both diagnostic and immediate therapeutic actions and intensive care admission should be considered.

The first reference quoted is 1927!!!

There is an alarming and dramatic example quoted too!!

If the doctor was fully aware of the lactate level, which she may have stated in her frank admissions after the event, then the buck, unfortunately, does stop with her.

It may well be that the lactate was left off the results, on a separate sheet, or even had the decimal point in the wrong place etc. etc. though............

But if she knew the level then it's the same as running a red traffic light.

RE: Is the veterinary profession heading this way?

Evelyn Barbour-Hill — Tue, 28 Aug 2018 01:27:22 GMT

[quote user="Michael Woodhouse"] I think I agree with the striking off, [/quote]

You've got to be kidding. Why not strike off the consultant? Why not srike off, or whatever the equivalent is, the hospital IT man? Why not strike off the hospital director for running a shambles?

Anyway, is the veterinary profession going this way? Striking off for negligence?

RE: Is the veterinary profession heading this way?

David Mills — Tue, 28 Aug 2018 01:07:35 GMT

[quote user="Michael Woodhouse"]

I don't know what to think about this case. I've read the detail and I absolutely agree that the consultant could have done more and that the system had issues. That said, this individual doctor did fail the child and it was potentially through her actions that the child died. She MUST be held accountable to that. I think I agree with the striking off, just not the criminal conviction.

[I agree this is one of the reasons I'm glad I'm a vet and not a doctor]

I'm not sure it has anything to do with her sex or colour.

[/quote]

Yes. It's somewhat a hair splitting sometimes between accountable and responsible. But the junior doctor did fail her patient, on the evidence available. Wasn't helped by the system or the person ultimately responsible. But on the front line, bedside, it was her that was in charge of immediate care.

The rest is postulation about race (just skim through the DC cases and look at the proportion of foreign vs UK vs registrants origin), but rather there should be questions asked regarding this - was there any point that her race legitimately led to a complaint e.g. Communication less well performed than a native English speaker. It is not racist nor xenophobic to ask this, because sometimes those with English as a second language or heavily accented can be perceived to communicate less well. It may be that English requirements are too low within the system of recruitment. But foreclosing these investigations in fear of claims of racism helps no one, not least the patients and families.

I'm writing a bit of my thesis about professional integrity at the moment. From the evidence available, fortunately, at present, it seems far more prevalent in the veterinary profession.

RE: Is the veterinary profession heading this way?

Michael Woodhouse — Mon, 27 Aug 2018 22:58:34 GMT

[I agree this is one of the reasons I'm glad I'm a vet and not a doctor]

I'm not sure it has anything to do with her sex or colour.

RE: Is the veterinary profession heading this way?

Iain Richards — Mon, 27 Aug 2018 22:21:24 GMT

What, one one person (I think) has said, is the essential aspect here. This was a systems failure that led to the incorrect decision by the doctor and the death of a child. As I understand it, in the manslaughter trial, none of the evidence of the systems failure was allowed. At the trial or possible the GMC appeal, Dr Bawa-Gaba's reflective journal was taken in to account. There, she honestly stated that she could have handled it better.

So to the original question, could it happen to us - potentially. With large groups selling to even more remote controlling bodies who will take no responsibility, who knows.

RE: Is the veterinary profession heading this way?

Anthony Todd — Mon, 27 Aug 2018 20:54:20 GMT

Wot's a word for blaming a perceived inferior being or culprit without mentioning race, religion sex, sexuality or skin colour?

RE: Is the veterinary profession heading this way?

Anthony Todd — Mon, 27 Aug 2018 15:46:08 GMT

[quote user="grumpyoldman"]The problem is dumping on an individual Dr. I think throwing her to the lynch mob probably was racist.[/quote]

Yes, the whole sorry affair would have been "handled" much more sensitively if said doctor was male, was a fifth generation medico, Oxford grad, as were all his fore-bears, and grandfather had been head of the BMA.......

RE: Is the veterinary profession heading this way?

Richard Carter — Mon, 27 Aug 2018 12:10:39 GMT

so in no way anything like the system described by Arlo in the airline industry then - 'blame and make them pay' rather than 'how do we make it better'.

think it is a noose that is tightening in fear for everyone in the medical, veterinary, emergency services and everyone else where a bad decision will be serious

so what is the result - less decisions being made, pass the buck, avoid getting into positions where you may have to make a decision (leave the profession sound familiar?), form a committee so the blame is spread out, make rules, SOPs... none of these good results to keep professionals being professional, able to make independent decisions, to act and get on with things.

we are already seeing it in the comments seen on this and other forums - no treatment until results back; refer as not sure and not prepared to guess and owners problem to find funding for referral, put to sleep as owner no funds for investigations, against practice 'rules', VDS won't support (I have actually phoned the VDS to ask if they have EVER put out a 'won't support' statement and their reply was that as long as action was with good reason, in good faith with scientific rationale and an action accepted by the profession as good practice, even if mistake eg wrong dosages or procedure failed they would be able to support/ defend the action so too many urban myths out there)

think the government needs to put a limit on litigation somehow otherwise there won't be anyone left.

Coming to work is supposed to be engaging, stimulating, advance/improve your knowledge and skills and hopefully make a difference for your patient. Working from a position of fear is reactionary not progressive.

RE: Is the veterinary profession heading this way?

grumpyoldman — Mon, 27 Aug 2018 01:32:55 GMT

We watched the Panorama and the things that sprang out were 1. Massive systems failure and cluster F***. 2. Junior Doctor Stitched up like a kipper by Tosser of a consultant. And I can quite easily see the same things happening again and again . It was the juniors failed attempts to get bloods ,the loss of results ,computer crashes that were as much to blame as any individual so if there was a crime it was corporate manslaughter form the NHS itself.

The problem is dumping on an individual Dr. I think throwing her to the lynch mob probably was racist. She was sacrificed to save the trust from a much larger litigation highlighting their system failures. It was similar to the problems in Stafford a few years ago.

RE: Is the veterinary profession heading this way?

Anthony Todd — Tue, 21 Aug 2018 14:24:08 GMT

[quote user="Jill Butterworth"]I think that's pretty much the crux of the case[/quote]

Mind you, her supervising Consultant didn't flag it at all......

RE: Is the veterinary profession heading this way?

Jill Butterworth — Tue, 21 Aug 2018 13:31:57 GMT

[quote user="Anthony Todd"]Why she didn't start massive ABs straight away [/quote]

I think that's pretty much the crux of the case, that antibiotic administration was delayed. The family are tortured by the thought that he might have survived if this was the case.

RE: Is the veterinary profession heading this way?

Anthony Todd — Tue, 21 Aug 2018 12:34:24 GMT

[quote user="Lucy Fleming"]I think you may have got this one the wrong way around[/quote]

Yes, I did....

"A normal pH is 7.34 – but Jack’s was seven and his lactate was also very high. A normal is about two and his was 11, so I knew then he was very unwell,” Dr Bawa-Garba says. She gave him a large boost of fluid – a bolus – to resuscitate him." My bold

From the BBC's summary.

Why she didn't start massive ABs straight away which, I understand, is standard practice in some places, and just based on the bloods alone.

This fact seems to have been ignored after that?

RE: Is the veterinary profession heading this way?

Lucy Fleming — Mon, 20 Aug 2018 17:07:15 GMT

[quote user="Anthony Todd"]

Oh yes, We all could read out vital, life changing blood results while lecturing..........

Total baloney, I'd say; how can anyone lecture and have immediate access to [a] the results and [b] a phone!

[/quote]

I think you may have got this one the wrong way around (or I have) - I thought Dr Bawa-Garba (junior) read out the results to O'Riordan (the consultant) at the handover when he returned to the hospital from his teaching committment (I tend to concur with what several others have said, the hospital should have taken priority, though leaving med students in the lurch and unable to study that day is hardly suggestive of a system that is working either!)

RE: Is the veterinary profession heading this way?

Anthony Todd — Sun, 19 Aug 2018 12:57:57 GMT

[quote user="Joyce Whitehead"]He was apparently lecturing as he had “double booked“himself.[/quote]

Oh yes, We all could read out vital, life changing blood results while lecturing..........

Total baloney, I'd say; how can anyone lecture and have immediate access to [a] the results and [b] a phone!

He, as the key culprit in the tragedy, has got off scot free!

And the hospital jobs-worths go through the ritual and usual charade of "lessons learned"!

RE: Is the veterinary profession heading this way?

Joyce Whitehead — Sun, 19 Aug 2018 11:17:54 GMT

He was apparently lecturing as he had “double booked“himself. I’m inclined to think the hospital job should have superceded the lectures tbh. No one dies if some students don’t get their lessons...

RE: Is the veterinary profession heading this way?

Anthony Todd — Sat, 18 Aug 2018 14:16:17 GMT

[quote user="sandpiper"]I do wonder at the lady's wisdom in undertaking so much on her first day back after a long break.[/quote]

But it wasn't her choice or decision. As I understand it, there was nobody else available, or even in the hospital, [although I wonder where supervising Consultant was geographically].

She was on her own, way out of her comfort, experience, and capability zone, "supervised" by a Consultant who was not really there in mind, and certainly not body!

I don't think Panorama actually established where the Consultant was and why, just that he was "doing 2 jobs"??

RE: Is the veterinary profession heading this way?

sandpiper — Fri, 17 Aug 2018 16:12:41 GMT

The consultant's near zero accountability was the most controversial element in my view. His defense that the seriousness of the case wasn't conveyed to him (and the disagreement about relay of the lactate level) is well below the level I would expect from a consultant and, the level expected of vet specialists and even more experienced first opinion vet colleagues. Yes, there may be trust and respect of the junior but, his qualifications, position and experience accord him accountability and responsibility to supervise, which must include oversight to consider that which might yet have gone undetected or been missed. That's His Job - not to say, like an inexperienced individual 'how was I to know, she didn't tell me', which is an answer more fitting of a junior doctor. If he didn't clock the situation and intervene - as a consultant - then with that logic, why should she be expected to as a junior? Perhaps he had other reasons or commitments that led him to absent himself at the time. His getting her to do an in depth self-critique which he used to help the powers that be snare her and completely evade culpability himself, rather shows his hand. The man moved out of the country a few months later - that's the cherry on top. Gotten off scot-free.

I do wonder at the lady's wisdom in undertaking so much on her first day back after a long break. Taking on too much probably happens regularly and and clinicians may worry about the real risk of compromising the level and standard of care they can realistically provide. With the myriad systemic problems, an episode of patient death like this may statistically have been more of a 'when' rather than 'if'.

I couldn't fault the intention to help out but it was also a very hard experience, perhaps, in learning one's own limits and being mindful of them. Saying no to taking it all on could have led to different outcomes all round.. including possible ward closure...!! Maybe then her consultant would have had to return to the hospital... who knows the domino effects.. students missing out.. But stemming from that then, should clinicians lay down the boundary to say - the staffing level is not out problem, we're each only handling a single ward rather than two, three or four.. What happens then - ward or hospital closure? Can the junior doctors say no? What consequences occur for them if they do say no? Are the perhaps more likely to limit their workload after this case where overload and systemic failings led to a manslaughter charge and more than five years of severe difficulty for the doctor?

RE: Is the veterinary profession heading this way?

Bob Russell — Fri, 17 Aug 2018 14:32:36 GMT

At least the NHS made the hospitals close the ambulance chaser compensation solicitors that were opening shops in the foyers!