Incompetent Vets

Re: Incompetent Vets

Mark Holmes — Tue, 03 Aug 2010 23:15:42 GMT

I think it speaks volumes that so many of us are unsure about the laws involving this. We have three issues ) what is the law 2) what is not the law but assumed to be so and 3) what is the law and shouldn't be.

Re: Incompetent Vets

Michael Woodhouse — Tue, 03 Aug 2010 22:45:05 GMT

[quote user="Hannah Wynne Richards"]

Micheal The law classifies IV injections, and indeed all injections as acts of veterinary surgery, and therefore illegal for anyone to perform unless :

a) veterinary surgeons

b) qualified veterinary nurses

c) veterinary students during the clinical years of the course

d)trainee veterinary nurses already enrolled with Royal College

e) owners, and in the case of farm animals, farmworkers, but only with their own or their employers animals

[/quote]

Where is this law? I have just had an enjoyable 20 minutes reading the 1966 VSA and the best I can find is:

TREATMENT AND OPERATIONS WHICH MAY BE GIVEN OR CARRIED OUT BY UNQUALIFIED PERSONS

Any treatment given to an animal by the owner thereof, by another member of a household of which the owner is a member, or by a person in the employment of the owner or of any other member of such a household.

I can find no specific mention of IV injections. The livery yard owner could be 'employed' by the owner to provide livery?

Where is this law written down Wynne?

Re: Incompetent Vets

Julian Earl — Tue, 03 Aug 2010 19:24:01 GMT

[quote user="Hannah Wynne Richards"]

Micheal The law classifies IV injections, and indeed all injections as acts of veterinary surgery, and therefore illegal for anyone to perform unless :

a) veterinary surgeons

b) qualified veterinary nurses

c) veterinary students during the clinical years of the course

d)trainee veterinary nurses already enrolled with Royal College

e) owners, and in the case of farm animals, farmworkers, but only with their own or their employers animals

[/quote]

Not that I don't believe you, but are you sure? I have believed for years that there was an anomalous situation whereby owners could inject their own animals i/v because they are allowed to treat them, but that it was illegal to blood sample because that was entering a body cavity and therefore was an act of veterinary surgery. I stand to be corrected though.

Re: Incompetent Vets

Wren — Tue, 03 Aug 2010 14:33:07 GMT

[quote user="Michael Woodhouse"]

We get very excited about prostaglandings and sedatives but we hand out many hundreds of times more penicillin that many people are allergic to. It is much more likely that a client will prick their finger with penicillin than inject themselves with sedative. Yet does anyone check every single client isn't allergic to penicillin and make every client (farm and small) sign a liability waver? What if the person taking the injection or pills isn't allergic but their spouse/employee/yard girl is and injects them-self and dies?

[/quote]

I killed one of my own horses with a penicillin reaction once. It was IM and I drew back (always do) and got no blood. Horse dropped off the end of the needle and didn't survive. Horrific, but can you imagine if it had been a client's horse? OK, even worse can you imagine if it had been a client injecting their own horse, or a yard owner injecting THEIR client's horse?

I had a long and interesting chat with the VDS afterwards as frankly it worried me and put me off injecting penicillin for a few weeks. As a practice we regularly hand out penicillin for clients to inject. Food for thought, and this is only a 'fairly' safe antibiotic, not a sedative or estrumate. Losing my horse was tragic but a person dying is another situation entirely.

Re: Incompetent Vets

Edward Jones — Tue, 03 Aug 2010 14:25:04 GMT

Some people don't half get their knickers in a twist about an i/v injection.

Re: Incompetent Vets

Hannah Wynne Richards — Tue, 03 Aug 2010 10:16:50 GMT

MeerM Your friend is happy to avoid a call-out fee, but why on earth should a practice be happy to cheat themselves out of a call-out fee by aiding and abetting a criminal act. The only reason I can think of, is that this is standard practice amongst all the practices in the area, so no-one dares be ethical as they would lose trade-a very sad situation

Wynne

Re: Incompetent Vets

Hannah Wynne Richards — Tue, 03 Aug 2010 10:06:23 GMT

Micheal The law classifies IV injections, and indeed all injections as acts of veterinary surgery, and therefore illegal for anyone to perform unless :

a) veterinary surgeons

b) qualified veterinary nurses

c) veterinary students during the clinical years of the course

d)trainee veterinary nurses already enrolled with Royal College

e) owners, and in the case of farm animals, farmworkers, but only with their own or their employers animals

MeerM's friend being a livery yard owner does not fall into any of these categories with respect to client's horses, so she was illegal if administrating any injection (not only IV ) to a client's horse My understanding of the law on manslaughter is that it is an illegal act that results in the unintentional death of another. Therefore, if a veterinary surgeon trips, and injects a whole syringe of dom/torb into a groom,(worst case scenario ) the coroner will call it accidental death. If a livery yard owner does so, when attempting illegally to inject a customer's horse, it will be manslaughter, and the veterinary surgeon who supplied the drug will have aided and abetted

When I 1st qualified and there were no VNs, only RANAs, whose legal status was that of lay people, it was illegal to allow them to give any injections

The above is criminal law, and therefore cut and dried. With respect to allowing clients to give IV or potentially dangerous IM injections to their own animals, we get into the realms of civil law , which is far more ambiguous. We seem to have drawn the short straw. It's not actually illegal, but if a client gets it wrong, then they can still sue the prescribing veterinary surgeon for allowing them to do something which they themselves had requested.,

If we had all had enough sense to stick together as a profession, and just say no, these situations would never have arisen, and yes, it has been the thin edge of the wedge, which has now grown into a very hefty big wedge which has caused the problem

Wynne

Re: Incompetent Vets

Michael Woodhouse — Mon, 02 Aug 2010 23:25:53 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Michael Woodhouse"] I have seen Vets working at the RVC do so (left iv oxytet for a horse after showing the owner how to do it).[/quote]

Did the horse survive?

[/quote]

I have no idea. Went out on the ambulatory practice from the college. During my time on the rotation we never went back to see it. Was for some kind of lung problem.

My question - is it actually illegal or do we think it's just 'not done'?

Re: Incompetent Vets

Evelyn Barbour-Hill — Mon, 02 Aug 2010 23:18:27 GMT

[quote user="Michael Woodhouse"] I have seen Vets working at the RVC do so (left iv oxytet for a horse after showing the owner how to do it).[/quote]

Did the horse survive?

Re: Incompetent Vets

Michael Woodhouse — Mon, 02 Aug 2010 22:57:01 GMT

[quote user="MeeraM"]but they have also left Buscopan and IV sedation for use as necessary[/quote][quote user="MeeraM"] she knew how to do IV injections and had done a few.[/quote]

Most of our dairy farmers are routinely putting calcium iv. Most are dirty and use the milk vein but some are confident with jugulars. I don't see the iv thing as a particular issue. I know that an animal owner and their employee is legally allowed to inject animals. Are iv injections specifically banned in law?

Frequently I will leave a course of antibiotic injections for a horse for the owner or their agent to give. I personally wouldn't leave iv drugs but I have seen Vets working at the RVC do so (left iv oxytet for a horse after showing the owner how to do it). I wonder how effective the oral Domosedan gel will be in horses?

All this worrying really isn't good for most of you

[quote user="MeeraM"]I am unsure as to what to do TBH....[/quote]

You do what you feel is right. Myself I would let it slide. There is always the possibility that things have been a little embellished. "A few iv's" may be one, the sedative might have been left as a one off for a specific purpose etc. I would be careful reporting anything on 2nd hand fact.

Re: Incompetent Vets

Julian Earl — Mon, 02 Aug 2010 22:11:54 GMT

[quote user="MeeraM"]

The original question poses an interesting dilemma.

I am in a quandary at the moment; a friendly (non-veterinary) chat with a friend this afternoon led inevitably onto veterinary matters (as it always does!) - and I was slightly shocked to hear what drugs her vets allow her to administer (without veterinary supervision) to animals on her premises (her own animals and also animals belonging to her clients. Clients presumably have given consent for medications to be administered as "required"). I am concerned as some of these medications are definitely NOT to be applied by a non vet (e.g. AW4 cream), but they have also left Buscopan and IV sedation for use as necessary. The back-breaking straw for me today was hearing that they had left IV sedation to be administered by the yard owner so that the EDT could remove a "split wolf tooth" from one of the horses when he next visited, without the requirement of a vet visit!!!! I expressed concern of the "Your vet practice frightens me" type - my friend blushed and replied rather shortly that she knew how to do IV injections and had done a few. I ran out of words at this point....

I feel that the above practices should be strongly discouraged (and I am disgusted/horrified by what I learned today), but I understand how important solidarity is between vets and I am unsure as to what to do TBH....

[/quote]

I thought these days were gone. "Someone I know" worked with vets who dispensed prostaglandin for goats and cows; Rompun for cows; Domosedan for sedating horses; Buscopan for horses with colic, and... chloramphenicol for lambs with watery mouth. (Ah, but chloramphenicol worked, you see...)

A bit of foot-stamping and it stopped, eventually.

Re: Incompetent Vets

Kate Richardson — Mon, 02 Aug 2010 21:22:28 GMT

[quote user="MeeraM"]I suppose now that I have raised the issue on a public forum, if anything untoward happens and investigations occur, I am potentially at risk of reprimand for not reporting the incidences?[/quote]

I don't think you will be at risk- you have done nothing wrong and it's only hearsay. The problem with horsey people is they are very fickle. One minute your friend, next minute they are not. I'm not suggesting your friendship has no value, I am sure it does. But when things go wrong, especially if it involves losing a horse or especially money, then things can change very quickly. Unfortunately as is often the case, to have horses you need money; people with money are very good at looking after their own. Your friend should be careful, as if things go wrong, she could also find herself being accused as part of the 'cause'. I think she should just refuse to give iv injections and explain why. But she is probably under pressure to do so and if the vets are willing to leave the drugs (which they absolutely should not) are they doing so because she is 'happy' to administer them? Does she get the owners to sign a disclaimer? For any injection even penicillin?

Re: Incompetent Vets

MeeraM — Mon, 02 Aug 2010 20:17:38 GMT

This is unlikely to occur, but I realise that this is one of quite a few hazards associated with administering IV sedation to a horse.

My friend is indeed a livery yard owner who has administered IV medication to a client's horse (with client consent). She has already had one instance of an intra-arterial injection of Buscopan several years ago. I have aired the dangers of administering IV medications to horses, but though she sheepishly agreed with what I had to say, she sees only the financial benefits of no call-out fee - and the pide of being trusted by her vets to safely give the drugs.

I am still undecided as to what to do. I suppose now that I have raised the issue on a public forum, if anything untoward happens and investigations occur, I am potentially at risk of reprimand for not reporting the incidences? The other trouble is, if I approach the RCVS and they become involved, I suspect the practice and client will deny all knowledge of any of the aorementioned events. I have no hard proof, the practice will know through their client exactly who has aproached the RCVS, and I will lose a good friend .

Re: Incompetent Vets

Hannah Wynne Richards — Mon, 02 Aug 2010 18:06:49 GMT

I really am talking to myself here, but MeeraM , an even worse scenario would be if this IV sedation was Domosedan, and a full syringe was injected into the person holding the horse. The veterinary practice that left it would be lucky to escape a charge of corporate manslaughter

Wynne

Re: Incompetent Vets

Hannah Wynne Richards — Mon, 02 Aug 2010 18:01:27 GMT

What I really don't understand is why we as a profession don't scrupulously obey the law when it's to our obvious financial benefit to do so . The law says that certain procedures are illegal for anyone other than a veterinarian to perform, so if we as a profession ALL observed this law then we would have more work, and therefore more money. Instead many of us seem willing to break the law, and risk prosecution by aiding and abetting lay people to perform veterinary tasks, when we lessen our own income by doing so

Insanity ????????????/

There is a loophole in the VSA that allows farmers and farmworkers to perform certain veterinary tasks (not involving entry into a body cavity) but it seems from MeeraM's post that her friend was a livery stable owner, so it's absolutely illegal for her to give IVs to a customer's horse

Re: Incompetent Vets

Hannah Wynne Richards — Mon, 02 Aug 2010 17:46:08 GMT

Mark Interesting ethical point about referring down

My usual approach is to advise "proper treatment " (with an estimate ) and negotiate which bits to leave out if the owner can't/won't afford it. Sometimes with medical cases, it becomes a weeks course of antibiotics and hope for the best-the academics will now crucify me !!!!!!!!!!!

In the case of your fracture, I would probably (under protest ) end up pinning without radiography-after all I didn't have an Xray machine for my 1st 2 years in practice (early 80s ) so I have trained fingers. I wouldn't be happy about a patient with a fracture suffering further transport

The other problem with referring down is what if you land a neighbouring practice with a bad debt, but it's worth thinking about in some cases

Wynne

Re: Incompetent Vets

Hannah Wynne Richards — Mon, 02 Aug 2010 16:57:44 GMT

I think the problem started when farm practice altered from a lot of small farmers, who were generally respectful of professional people (and when losing 1 client would not have much of an impact on the "bottom line " ), to a few much bigger farmers who knew how to make use of their financial clout, and started threatening to leave for a more ethically -accomodating practice. The list of drugs to be left on farms, or in stables just grew

The fat would be in the fire if an unqualified lay person administered something intra-arterial to a valuable horse which was not their own, and killed the poor horse, then was sued by the owner, and stated in defence that the veterinary surgeon had supplied it

Wynne

Re: Incompetent Vets

Bob Russell — Mon, 02 Aug 2010 15:12:32 GMT

[quote user="Phil Elkins"]

[quote user="MeeraM"]

I just don't get WHY a vet practice would put themselves in such a position??

[/quote]

I have worked with people who would do similar (such as leaving xylazine at a farm to sedate a bull to have it's hooves trimmed), and saw practice with similar vets. I think if you have the courage of your convictions, and are a better person than I then you should report them. I wish it could be done anonymously, but now working for a pratcice that finds making enemies of other vet practices a weekly passtime, I'm glad that reports aren't anonymous.

[/quote]

Having previously stated that I do not believe in anonymous reports these examples horrify me to the point that I could change my mind. Sedatives are by their very nature potentially very dangerous drugs. I suspect that if DEFRA did a farm visit and found them on-site heads could roll.

I do not do farm work now but is it right that all medicines administered need to be clearly recorded and signed off by the prescribing vet?

Is this the situation with most horses as well? Correct me if I am wrong - it has been a long time since I did large animal work and things have changed a lot!

Re: Incompetent Vets

Phil Elkins — Mon, 02 Aug 2010 10:44:37 GMT

[quote user="MeeraM"]

I just don't get WHY a vet practice would put themselves in such a position??

[/quote]

Re: Incompetent Vets

MeeraM — Sun, 01 Aug 2010 18:58:06 GMT

Illegal - and the EDT concerned is not even registered.

I just don't get WHY a vet practice would put themselves in such a position??

Re: Incompetent Vets

Evelyn Barbour-Hill — Sun, 01 Aug 2010 18:20:00 GMT

[quote user="MeeraM"]the EDT could remove a "split wolf tooth" from one of the horses when he next visited, without the requirement of a vet visit[/quote]

Illegal anyway.

You are in a dilemma, Meera, that's understood. And things are not always black and white.. But the route exists for you to raise this in confidence with RCVS, if you think it important enough to outweigh the consideration that it will upset and cause trouble for your fellow veterinary surgeon and for your friend. Sometimes it's better to speak out but sometimes it's better to let things slide. Only you, after consulting your conscience, can decide. I think you made a good start by expressing yourself forcibly to your friend. Keep her as your friend and you might be able to influence things further.

Re: Incompetent Vets

MeeraM — Sun, 01 Aug 2010 01:10:26 GMT

The original question poses an interesting dilemma.

Re: Incompetent Vets

Colin Cameron — Tue, 27 Jul 2010 16:06:59 GMT

[quote user="Cat Henstridge"]Many of these people don't do things which would get them stuck off/reported through the normal channels, more that they practice poor veterinary medicine [/quote]

In whose opinion?

Who judges the judges?

[quote user="Cat Henstridge"] I am sure we all know at least one vet who does some dubious things [/quote]

Absolutely! And some are so-called experts in their fields, not just the ones who should not be allowed near anything still living. To which group do you refer?

Re: Incompetent Vets

Colin Cameron — Tue, 27 Jul 2010 13:48:41 GMT

[quote user="Mark Holmes"]Owner can't afford £2000 referral[/quote]

It must have been a hell of a fracture? Or is the lease due on the 911?

Re: Incompetent Vets

Mark Holmes — Tue, 27 Jul 2010 13:41:24 GMT

In fact I think I might post this as a thread for discussion as I would be interested to see where it goes.