John Kenward MRCVS, a director of Maidstone practice Pet Emergency Treatment Services, has been given a conditional discharge for allowing an employee to X-ray her own foot after a horse stamped on it.

Maidstone Magistrates heard that the employee, a 25 year-old vet and equine intern, was afraid the foot was broken and she might be unable to do that evening's on-call duty.

As a result, she rang Mr Kenward. As they were both concerned she could be held up in hospital A&E, Mr Kenward suggested she use the in-house X-ray kit. He gave her the settings to use and she carried out the test, which showed no break so she continued to work as normal.

Another director, who acts as Radiation Protection Supervisor, later noticed a human image on the digital processor. This led him to notify other practice board members of his intention to interview staff about the suspected breach of site radiation safety policy. He was immediately told by Mr Kenward not to discipline the vet intern as he had suggested that she use the X-ray.

As a result the Health and Safety Executive was contacted and an investigation confirmed a breach of radiation regulations.

Although the vet intern, from Maidstone, was the only person present during the X-ray exposure, she did not wear a personal dosemeter during the procedure.

However, HSE told the court that Mr Kenward was fully aware that the rules of the practice clearly stated nobody should be placed within the beam of the X-ray machine.

Mr Kenward was ordered to pay £1,296 in costs after admitting a breach of the Health and Safety at Work etc Act 1974.

After the hearing, HSE inspector Rob Hassell said: "Any vet practice using ionising radiation for medical exposures must ensure that the X-ray equipment is properly maintained and that the requirements of the Ionising Radiations Regulations are complied with. The view of HSE and the Department of Health is that it is highly unlikely that all these conditions can be met by a veterinary practice.

"It follows therefore that X-rays must not be taken of human beings at practices. We are aware that the X-raying of people may not be unique to this particular practice so I hope others will take note that HSE is prepared to prosecute if such breaches come to light."

A survey by VetSurgeon.org has found that the majority of veterinary surgeons disagree that they should be allowed to prescribe medication without ever having seen the animal in person or performing a physical exam.

The survey was conducted following the recent RCVS Council decision to redefine ‘Under Care’ to allow vets to prescribe remotely.

692 veterinary surgeons took part in the survey, 88.7% of which worked in practice, 8.7% worked elsewhere and 2.6% are retired.

42.4% worked in corporate practice, 42.4% at an independent practice (spooky), 9.6% locum and 2.6% at a charity.

94% worked in first opinion practice, 5.7% in referral practice.

When asked: “Do you agree with the RCVS Council decision to allow veterinary surgeons to prescribe medication without having seen / examined the animal in person?”, 78.2% said no, 13.6% said yes and 8.2% said ‘ambivalent’.

This raises an interesting discussion about the role of RCVS Council, which the College has long said is ‘representative of’, but not there 'to represent’ the profession in self-regulating.

By any measure, this decision was not ‘representative of’ the wider body of opinion.

It could be argued that electorates vote for representatives to make more informed decisions than they themselves are able, and certainly MPs have voted in ways that are not representative of the wider body of public opinion.

But this is the veterinary profession. MPs have to represent a wide cross-section of society, some groups of which might struggle to field one working brain cell between them.

By contrast, veterinary surgeons are a highly intelligent, highly educated subset of the population, who you might assume are better qualified to make decisions on matters such as these.

So why this level of disagreement? We asked respondents to select any benefits and drawbacks they think remote prescribing will bring, from a list but with the option for them to write in any we hadn’t thought of.

When asked to select benefits of remote prescribing, the majority (70.9%) selected: “Reduced cost to the pet owner (driving/parking etc)’.

39.3% said it would bring an improvement to vets’ quality of life through more flexible working.

27.5% said animal welfare would be improved through increased access to veterinary services.

14.3% said it would bring an ‘Improved client/vet relationship’.

Of those people who selected a benefit, 49.9% said the biggest benefit of remote prescribing is a reduced cost to the pet owner (driving / parking etc).

Other benefits highlighted in the comments section were

• Animals will receive care when physical exam is not possible, such as client illness or remote areas.
• Ease of some chronic conditions if owner stressed by attending clinic
• Easier access to prescription flea and worm treatments
• Environmental benefit of not driving to vets unnecessarily
• For fearful animals that need pre-visit meds
• Frees up clinical time
• If only used for existing clients, can improve relationships by offering better access
• Improved time management so better work life balance
• Legitimises present working practices
• Mitigation of veterinary recruitment gap
• Not having to examine the psychopaths

Notably, in the comments section for the benefits of remote prescribing, out of the 104 comments, 33 actually commented 'no benefit' or negatively.

When asked to select the drawbacks of remote prescribing, 94.3% selected: ‘Harm to animals caused by misdiagnoses and missed diagnoses.

68% said: Worsened client / vet relationship

60.6% said: Threat to independent practice (corporates funnelling clients from online consults to their practices).

Other drawbacks identified by respondents were:

• Abuse of drugs (getting drugs from multiple sources with the same animal and selling them on)
• Deskilling of new grads
• Antibiotic resistance
• ‘Us and them’ in the profession
• Clients demanding remote prescription of inappropriate drugs
• Reduced continuity of care
• Devaluing a consultation
• Will increase costs to owner
• Increased stress for vets
• May make in house OOH less viable.
• Loss of trust in the profession as clients get different advice from vets online than off.
• Overprescribing
• Reduced compliance for follow up tests
• Reduced status and respect for the profession

Amongst the written drawbacks, the biggest themes concerned abuse of drugs and antimicrobial resistance.

When those who had selected a drawback were then asked which was the biggest, 83.3% said ‘Harm to animals caused by misdiagnoses and missed diagnoses”

So in simple terms, in weighing up the pros and cons, it’s between the reduced cost to the owner on the one hand, cited by 70.9%, and harm to animal welfare on the other, cited by 94%. And the harm to animal welfare was selected by significantly more vets as the biggest concern, than reduced cost was selected as the biggest benefit.

In other words, vets think remote prescribing will make veterinary care cheaper, but at the overall cost to animal welfare.

British Veterinary Association President Malcolm Morley said: “New technology presents many opportunities to enhance existing veterinary services, with potential benefits for vets, clients and patients.

"However, we recognise there are concerns within the profession, particularly around the potential unintended consequences of the RCVS’s revised guidance on ‘under care’ in relation to animal welfare and access to veterinary services. 

"This survey echoes these concerns as well as supporting the British Veterinary Association’s call for the RCVS to commit to a post-implementation review.”

Devon vet Jo Dyer has launched a petition for the RCVS to remove mandatory house visits from the Code of Professional Conduct, in response to the College's call for evidence on the provision of 24-hour emergency veterinary cover.

Clause 3.13 of the Code currently says: "Clients may request attendance on a sick or injured animal away from the practice premises and, in some circumstances, it may be desirable to do so. On rare occasions, it may be necessary on clinical or welfare grounds. The decision to attend away from the practice is for the veterinary surgeon, having carefully balanced the needs of the animal against the safety implications of making the visit; a veterinary surgeon is not expected to risk 'life or limb', or that of anyone else to provide the service."

In other words, whilst it is not mandatory to accede to every request for a home visit, the Code starts by saying: 'it may be desirable' and 'it may be necessary', thereby implying that the veterinary surgeon will need to explain themselves if they decide against.

Jo argues that this ambiguity, coupled with outcome of recent disciplinary cases and the risk, however small, of losing one's livelihood, means that there are many practitioners, particularly younger and less experienced graduates, who are now fearful of refusing home visits, rendering them to all intents and purposes mandatory. It's a situation compounded by the perception that if push comes to shove, a practitioner's actions will be judged by a Disciplinary Committee whose members may be out of touch with the sometimes harsher realities of life in practice.

Jo also points to the increased risk of assault that practitioners face when making home visits, rather than treating the patient from the relative security of the practice premises. She also makes the point that leaving a practice unattended (as can happen if the only vet on the premises has to go on a home visit), may compromise the welfare of any other animals that need emergency treatment in the meantime. 

The petition calls for the complete removal of clause 3.13 from the Code, and for clause 3.2 to be amended to read: 'The responsibility for the welfare of an animal rests primarily with the owner, keeper or carer of the animal. Veterinary surgeons are unable to make a definitive decision regarding diagnosis and treatment until they have undertaken a physical examination of an animal. This examination may take place at the surgery or other address entirely at the discretion of the veterinary surgeon on duty. It is expected that farm animals and equines will mainly be examined away from the surgery and pets at the surgery."

Jo said: "It is important to stress that I am not calling for the abolition of home visits, and nor do I think this would be the effect of my proposed change to the CoPC. The profession is almost entirely made up of people who care desperately about the quality of the service they offer, and who want to offer the best to their patients and their clients. Of course we'll continue to make home visits. But I do feel passionately that the decision in each case must rest unambiguously with the veterinary surgeon concerned and not be subject afterwards to the judgement of others."

To sign the petition, visit: http://www.change.org/en-GB/petitions/royal-college-of-veterinary-surgeons-remove-mandatory-house-visits-from-the-code-of-professional-conduct

So, after months of speculation, the Panorama documentary: It shouldn't happen at a vets' finally aired last night. Early reaction from most of the profession seems to be one of mild relief that by focussing so heavily on Medivet, the documentary has left everyone else more or less unscathed.

There's also a great deal of sympathy for those hard-working and professional vets and nurses who work at Medivet. They're the biggest losers in all of this, tarred by the indefensible behaviour of a very small number of colleagues, and by the very nature of most of the filming in the documentary (give me a fish-eye lapel camera, and I could make even Mother Theresa look like a crack dealer).

But can everyone else really sit back, think 'not my problem', 'sensationalist rubbish', or 'it'll blow over in a week' and move on?

If you consider only the more headline-grabbing elements of the documentary, any of those would be a reasonable position to take. But look beyond 'Vet Makes Fraudulent Insurance Claim', and it seems the producers might accidentally have hit upon some big challenges facing the profession. Might now be a good moment to reflect on and debate some of these issues? 

The first story covered by the documentary was that of an owner who'd found their cat 'weeing blood', taken it to Medivet and been quoted £815.05 for a bank of tests. They'd left in disgust, and visited another practice. This one gave a diagnosis without tests, the bill for which came to 75 quid, including £28 worth of food.

Veterinary costs were a recurring theme throughout the documentary. At the start, Jeremy Vine pointed out the £20,000 lifetime cost of owning a dog, and the £15,000 cost of owning a cat. He said vet bills have trebled in a decade. Mid-way through the programme, the voice-over read: "Veterinary medicine is increasingly high tech, and increasingly expensive. The new generation of vets is taught that working up to an accurate diagnosis may involve extensive tests. More veterinary work means more costs. And later in the documentary, Alex Lee, the reporter, was said to have found evidence of two clients that had spent over £100,000 on their pets over a ten year period.

At the end of it all, the real issue is not about the disparity between one vet's bill and another's, but whether the profession is becoming over-qualified or over-equipped for the job, and consequently at risk of pricing itself out of the market. 

Commenting on state-of-the-art care, Professor Innes from the University of Liverpool said in the programme: "We would never push clients into procedures that are unnecessary, but if people want to access the best healthcare for their pet, that's up to them."

Surely every pet owner wants to access the best healthcare for their pet? Of course, Professor Innes is right, there is a market for complex procedures and diagnostic tests. But there's a very fine line between 'pushing' a client into a procedure, and recommending a procedure (to someone who feels emotionally duty-bound to do the best for their cherished pet).

For me, it was ironically one of the Medivet staff who seemed to hit the nail on the head when she said: "The 'Medivet Way' is to work it up to find out why straight away, so... And people can't afford it now really, you know."

Is the word 'Medivet' in her quote interchangeable with a growing list of practices? Does something need to give? Is it time to call a halt to the development of increasingly complex procedures and diagnostic tests developed to save the life of what is, after all, just a cat or a dog?

Or is it a question of veterinary surgeons ceasing to recommend any particular treatment above a certain cost, and instead simply laying out the options available to the client: "Mrs Jones, you've got three options here. Option one is my best guess, and I might be wrong. Option two is my best guess plus these tests, which will help confirm whether I am right and will cost x. Option three is referral to the world's leading expert, who is based in Dallas, but that'll give time for the MRI on board the specially chartered 747". I'm being flippant, but my point is a serious one: as more expensive treatment and diagnostic options become available, so it becomes ever riskier recommending them, rather than simply informing the owner of their choices.

The next story was an important one too. It was the one where a student nurse and the unqualified reporter were tasked with catheterising a dog unsupervised. They struggled. As did the dog. Thanks to the hidden camera, and the reporter interjecting: 'What a nightmare', it made for dramatic TV. But as many have commented in the VetSurgeon forums, a difficult to catheterise dog is not exactly out of the ordinary. And who thinks this was the first time the procedure has been done by lay staff?

More interesting was the polar opposite interpretations of the law on this issue expressed by Medivet on the one hand, and Professor Sandy Trees for the RCVS on the other. In response to the question of whether a trainee should be placing a catheter, Jeremy Vine read from a statement in which Medivet insisted that everything it allows its trainees to do is legal, and that there was no definitive list of procedures that could be carried out by trainees. Two minutes later, and we had Professor Trees appearing to contradict Medivet's statement.

Then we see the reporter and a student nurse taking a blood sample from a cat, before the arrival of a vet. Medivet says: "This procedure was completely legal, normal and was carried out at the direction of a vet. This means that the vet does not have to be present at the time. [The tasks] were not illegal. The trainee veterinary nurses were properly trained and experienced. RCVS inspectors have never raised this as an issue, and it is common practice." But when Jeremy Vine then asked Professor Trees: "Would it be OK for a student veterinary nurse to take a blood sample before a vet arrived into the practice", the answer is no. When pressed: "So supervision means that the vet has to be in the building", Professor Trees hesitates before delivering his more ambiguous reply: 'I would say so, yes'.

How on earth did that happen? How did one of the biggest veterinary groups come to be at loggerheads with the regulator on TV? Remember that Medivet would have had some time to prepare its response, and presumably had it checked by a team of lawyers first. Professor Trees may or may not have had the luxury of as much warning. Still, if el Presidente himself cannot give more than a personal opinion in answer to such an important question, something is amiss. After all, people's careers are at stake here.

The issue here is whether regulation needs to become more prescriptive. For example, is it fair that the responsibility for defining precisely what is 'minor surgery (not involving entry into a body cavity)', and therefore able to be performed by a qualified veterinary nurse, currently rests with the individual veterinary surgeon. And if it comes to it, the only way the veterinary surgeon is going to know whether he or she made the right call is if and when it comes to be tested in court.

Talk about closing the stable door after the horse has bolted.

Surely it is time now, particularly in the (like it or not) increasingly corporate and less personally accountable world we live in, for the profession and everyone in it to have clearer leadership in terms of what is and what is not acceptable.

I won't dwell on any of the other stories covered by the documentary, because I don't think any of them are individually revealing of very much.

A student nurse struck a dog. 'Walloped' according to the reporter; 'smacked' according to an  onlooker. There's a difference. Either way, a difficult one to defend.

Then a member of staff (and I couldn't work out whether it was the vet or the nursing assistant) started playing with an anaesthetised kitten as if it were a puppet. That was damning for the lack of humanity it showed.

Next we saw a new grad trying to intubate a cat. For some reason, it didn't go as smoothly as it should. Some speculation in the VetSurgeon forums as to whether she applied the local anaesthetic correctly or not, but the cat was fine. Mistakes happen.

Next we saw a dog that had a condition which made it susceptible to cuts. A 'new girl' says she thinks she must have accidentally cut its pad as she closed the kennel door. Not the end of the world, except we then see the staff plotting to tell the owner that it happened before the dog arrived at the practice, and that they would need £13 worth of Fuciderm. Again, it isn't what you would call the crime of the century. But it was nevertheless a damning piece of film for the lack of honesty shown by the staff.

Then we had the case of the dodgy insurance claims, where the practice allegedly split what should have been one claim into three 'by accident', so that they could effectively increase the total amount the owner would be able to claim. Difficult to get really het up about this one. I mean, I know it's wrong. But it wasn't exactly in the same league as Lord Brocket taking the oxyacetylene torch to his car collection. And as far as I could see, the unwitting beneficiaries of this one were the dog and its  owner.  No, the real problem was that in the same breath as Medivet proclaimed its innocence, its employee was there in technicolor explaining exactly how and why the deed was done.

Guy Carter, one of the Medivet partners was next on the rack. The Panorama reporter alleged that he instructed staff to bill a client for a monitor that wasn't used. The company says it was. So it's their word against hers. Unfortunately, the company's word wasn't looking that good by this stage in the proceedings.

As I said earlier, these things don't individually tell anyone much. But collectively, I wonder whether they don't highlight another important issue, which is the apparent 'disconnect' (hate using the word like that, just can't think of a better alternative at this time of night) between what the public wants (i.e. a close, trusting relationship with an accountable James Herriot-type-figure, personified in the film by Bob Stevenson), and what the corporates can realistically deliver.

I was chatting about this with a locum vet this afternoon. His experience is that in small practices where the owner is present, there is always a better atmosphere. Staff take more pride in their work, and deliver a higher standard of care than in the corporates.

Isn't that really what the documentary showed? Yes, they were especially excruciating examples of how people behave when they don't have a real sense of ownership in a business. But isn't a lower, less personal standard of care an inevitable consequence of corporatisation?

Incidentally, my apologies for labelling Medivet a corporate rather than a partnership, but like it or not, that's the public perception of a chain.

Finally, the star of the show made his grand entrance. Kfir Segev, charged with recommending £2200 worth of MRI scan for a dog that was obviously dying. Now that is despicable. He's found guilty of unprofessional conduct, and struck off. I suppose 'vet commits fraud, is found out and punished' is not the stuff of which great documentaries are made, so Panorama tried to make something of the fact that he continued to work for 28 days whilst deciding whether to exercise his right to appeal. And? Perhaps sensing they still had a bit of a non-story on their hands, they tried to make an issue out of the fact that he'd continued to work as a practice manager after being struck off. It was all a bit lame, really.

Still, not as lame as the finale, which was the 'revelation' that Medivet collected blood from rescue dogs, in return for donations of food and supplies. Panorama claimed the blood was sold at a profit. Medivet claimed it is subsidised. Does anyone actually care either way?

Since the documentary was broadcast last night, Medivet has issued a further statement in which it does the honourable thing, and takes responsibility for everything it needed to. Medivet will recover from this. If the professionalism of the response is anything to go by, it will emerge stronger.

Still, the big questions remain. How to address the spiralling costs that accompany the latest advances. Can the profession afford, any longer, to leave so much to the discretion of the individual, or is it time to demand a more prescriptive regulatory environment? And finally, how can the corporates deliver the kind of service that the public seems to want? Doubtless there will be some who'd like them to fail in this regard. But as we've just seen, it does nobody any favours if they are allowed to do so in a way that threatens to bring the whole profession into disrepute.

Locum David John Porter has been struck off by the RCVS Disciplinary Committee for rude and aggressive behaviour, deficient clinical standards and obstructing the Committee's investigation into the complaints against him.

Three charges were found against Mr Porter.

The first charge (charge A) concerned failure to communicate courteously and respectfully with colleagues. This charge related to four incidents as follows:

• A1: On 3 November 2011, whilst on duty at the Seadown Veterinary Hospital in Southampton, he was rude and/or threatening and/or aggressive to two veterinary surgeon colleagues.
• A2: On 11 June 2012, whilst on duty at Clent Hills Veterinary Group, Worcestershire, he said to an assistant practice manager and receptionist that British veterinary surgeons and practice managers were untrustworthy.
• A3: On 12 June 2012, when on the telephone with the practice manager of Clent Hills, he was rude and/or used inappropriate language; and stated that a lot of British vets were “bloody awful”, liars and cheats.
• A4: In January 2013, during the course of an Employment Tribunal hearing in relation to his time as a locum at Clent Hills Veterinary Group in June 2012, he raised his voice aggressively and/or shouted at the Clent Hills practice manager.

In finding him guilty of this charge the Committee referred to his “wholly unacceptable exchanges with other veterinary surgeons and veterinary nurses and ancillary practice staff members with whom he was working on the dates in question.”

The second charge for which he was found guilty (charge C) concerned what the Committee called “his seriously deficient clinical standards when treating animals under his care”, in particular that:

• C1: Between 31 October 2011 and 4 November 2011 at Seadown Veterinary Hospital he used inadequate levels of hygiene when conducting surgery by failing to scrub up and/or wash his hands before surgery, including abdominal surgery.
• C2: On 26 April 2013 at the Stanhope Park Veterinary Practice he used surgical spirit to clean the ear canal of a dog.
• C3: On 27 April 2013 at the same practice, he unreasonably refused to euthanase a dog.
• C4: On 28 April 2013, at the same practice, he used a ratchet gag on a rabbit without having first administered sedation or anaesthesia.

Within charge C he was cleared of two further parts of the charge – first, that he failed to discuss euthanasia with a client in relation to a kitten and failed to provide the client with sufficient advice and instructions regarding after-care; and, second, that he prescribed steroids to treat a kitten for muscle strain at a time when it was recovering from surgery.

The third charge for which he was found guilty (charge D) relates to Mr Porter’s failure, between 7 February 2013 and 31 October 2014, to respond adequately to communications from the RCVS. In particular that:

• D(i): Between 7 February and 21 December 2013 he failed to respond constructively or at all to correspondence from the College.
• D(ii): From July 2014 he failed to respond to specific requests for details regarding his qualifications and experience.

As to the conduct found proved in relation to charge D, the Committee set out its findings of fact and declared: “What Mr Porter chose to do was to attempt to obstruct the College in its attempts to investigate the complaints laid against him and, thereafter, its attempts to bring him before the Committee to answer the charges preferred against him. In short, he has directly questioned, and then disregarded and thwarted, the legitimate role of his professional regulatory body.” 

The Committee’s reasons for taking a serious view of such conduct were expressed in the following words: “Both the public and other members of the profession must be entitled to rely on the expectation that all veterinary surgeons, as responsible professional persons, will co-operate fully and promptly to all proper enquiries made of them by the College. This is the wider public interest factor which means that deliberate attempts to thwart the College’s enquiries into complaints must, in our judgment, come at the top end of the spectrum of gravity of disgraceful conduct in a professional respect.” 

During the course of the hearing, which began in June 2015 and was adjourned three times, Mr Porter was cleared of charge B against him which concerned alleged refusal to undertake out-of-hours work for the Clent Hills Veterinary Group having previously indicated he would undertake such work.

In making the decision on the sanction in this case, Judith Webb, chairing the Disciplinary Committee and speaking on its behalf, said: “In reaching our conclusion as to the sanction which is merited in this case we have taken into account the totality of Mr Porter’s conduct and failings. We consider that the conduct pertaining to Charges D(i) and (ii), even when viewed separately, demand the imposition of a direction for the removal of Mr Porter’s name from the Register.

“When that conduct is considered in conjunction with the other misconduct found proved in relation to Charges C1 to C4, which identify his clinical failings, and Charges A1 to A4, which demonstrate unprofessional behaviour in the workplace, we unhesitatingly conclude that there is no other sanction that could be considered sufficient, other than that of erasure.”

The RCVS Disciplinary Committee has agreed to adjourn multiple charges against a Hampshire-based veterinary surgeon who first registered in 1950, following his undertakings firstly to request removal from the RCVS Register and secondly never apply to be restored to it.

At yesterday's hearing, William Bamber Cartmell of Wickham, near Fareham, was due to face seven heads of charge containing "serious allegations" relating to his provision of expert evidence in a case involving the RSPCA; his certification, following clinical examination, of the health of two horses for a prospective purchaser; and his clinical competence during treatment of a Cavalier King Charles Spaniel called Milly.

However, before the Committee considered any of the facts behind these charges - all of which Mr Cartmell denied - the College submitted an application suggesting that they should be adjourned, providing that Mr Cartmell agreed to the three undertakings (the third being not to act as an expert witness in litigation in future). The College also suggested that, should Mr Cartmell subsequently apply to be restored to the Register, the Committee should resume its consideration of the charges, along with his breach of the undertakings.

The Committee was advised that none of the complainants in the case - which could have exceeded four weeks and incurred considerable costs - dissented from the proposed course of action. It also heard that Mr Cartmell had recently retired from his practice, which was now closed and his clients dispersed to other practices. In over 60 years of practising, there had been no adverse disciplinary findings against him.

Speaking on behalf of the Disciplinary Committee, its Chairman, Professor Peter Lees, said: "Having carefully considered the matters put before us, we have concluded that it would not be in the public interest to refuse the College's application and proceed with this case.

"We are satisfied that the undertakings offered by the Respondent protect the welfare of animals and uphold the reputation of the profession. [These undertakings also] go beyond any sanction that this Committee could impose at the conclusion of a contested hearing where any of the heads of charge were found proven.

"We do not consider that it would be proportionate for either party to incur the substantial costs of a contested hearing. We have also paid particular regard to the age of the Respondent and to his length of service without any adverse findings having been made against him."

Surrey veterinary surgeon Kumaran Kanesh has been struck off by the RCVS Disciplinary Committee after being convicted in the Crown Court for wounding with intent and false imprisonment.

At the one-day hearing, the Committee heard how Kumaran Kanesh, who completed his veterinary studies in Sri Lanka before moving to the UK in 2003 to undertake further studies, had been sentenced to four restriction orders under the Mental Health Act at the Kingston Crown Court on 25 March 2013, following his attack on a woman and child in August 2012.

During the summer of 2012, following a period of worsening mental illness and increasing paranoia about people, Mr Kanesh had launched a pre-planned assault against Mrs A and Child B. In what the Crown Court Judge described as an extremely violent, deeply distressing and seemingly frenzied attack, Mr Kanesh bound and gagged Child B and Mrs A, before proceeding to cut Child B's eyelids with a knife. When Mrs A managed to free herself and tried to protect the child, Mr Kanesh then attacked her, stabbing her 17 times in the subsequent struggle. Both Child B and Mrs A ultimately managed to escape, where they were assisted by members of the public, before the police arrived to arrest Mr Kanesh. The Committee noted that both Mrs A and Child B had since made a good physical recovery from their injuries, although their psychological well being was still in question.

Following the attack, Mr Kanesh was remanded in custody before being transferred to Broadmoor Hospital, where he was retained under the Mental Health Act until sentencing. Consultant psychiatrist Dr Samrat Sengupta told the sentencing hearing that Mr Kanesh suffered from paranoid schizophrenia with symptoms characterised by "persecutory and self-reverential delusional ideations" about members of his family and the wider public. He added that the degree of Mr Kanesh's illness warranted his ongoing hospitalisation and treatment, and that the possibility of relapse from failing to take his medication was a real concern. Passing sentence, his Honour Judge Price QC told Mr Kanesh: "Because of your untreated illness, your mental illness overwhelmed you and you behaved in an extremely violent and deeply distressing way ... I am quite satisfied that you committed those acts while suffering from mental illness. The tragedy is that if you had taken the medication then perhaps none of this would have occurred."

At the outset of the Disciplinary Committee hearing, which Mr Kanesh attended escorted by a mental health nurse, he admitted the convictions and that they rendered him unfit to practise veterinary surgery. Mrs A had written to the College stating she was supportive of Mr Kanesh and that she understood his behaviour had resulted from his ill-health. Dr Sengupta also wrote to the College stating that Mr Kanesh had since responded well to medication with complete resolution of his symptoms and had been moved to a lesser secure environment for further rehabilitation.

In its submissions to the Committee, the College stated that Mr Kanesh's convictions represented some of the most serious offences that it could consider, which, had he been of sound mind, would have led to a significant period of imprisonment. His conduct was of such an exceptionally serious nature as to significantly damage the reputation of the veterinary profession and undermine the public's confidence in it, regardless of the underlying reasons. The Committee accepted the College's submissions and found Mr Kanesh unfit to practise veterinary surgery.

In determining an appropriate sanction, the Committee acknowledged that Mr Kanesh was suffering from a severe, acute psychiatric disorder and was unknown to the UK mental health services at the time of the incident, but noted that he had caused serious physical and mental harm to two individuals, and that his actions had involved a breach of trust, a vulnerable victim, premeditation and a high level of violence.

Speaking on behalf of the Disciplinary Committee, its Chairman, Professor Peter Lees, said: "The seriousness of these offences is self-evidently damaging to the reputation of the veterinary profession and the confidence of the public in the profession. [We] accept that if [Mr Kanesh] fails to maintain his regimen of medication, there is a real risk of a possible relapse ... The only possible sanction in this case is to direct the Registrar to remove [Mr Kanesh's] name from the Register."

The full detail of the Committee's decision is available on the RCVS website (www.rcvs.org.uk/disciplinary).

The British Association of Homeopathic Veterinary Surgeons is claiming that: "owners can now be confident homeopathic medicines can be effective for common canine and feline conditions in many animals, following a recently published clinical study." 

In what the BAHVS says was the largest-ever study of its type, the Clinical Outcomes survey has identified a number of clinical conditions in dogs and cats that homeopathic veterinary surgeons believe may be promising targets for future research in veterinary homeopathy. 

In the study, twenty-one homeopathic vets in the UK recorded data from their patients over a 12-month period, and collected information from a total of 1500 dogs and 400 cats. The most frequently treated feline conditions overall were dermatitis, renal failure, overgrooming, arthritis and hyperthyroidism.  The most commonly recorded canine conditions were dermatitis, arthritis, pyoderma, colitis and fear. By owners' assessments, a moderate or major improvement was reported overall for 68% of dogs and 63% of cats.

The authors of the study concluded that a programme of controlled research in homeopathy for frequently-treated feline and canine conditions is clearly indicated.

John Alborough, co-publisher of VetSurgeon.org said: "I also find that if I shove toenail clippings up my bottom, it totally cures my indigestion."

Reference
Mathie RT, Baitson ES, Hansen L, Elliott MF, Hoare J. Homeopathic prescribing for chronic conditions in feline and canine veterinary practice. Homeopathy 2010; 99: 243-248.

A German Shepherd bitch is making an impressive recovery from serious burns, after treatment with manuka honey impregnated dressings.

'Lady' sustained her injuries after being trapped in a blazing house in Cornwall, as reported by the BBC. She has since been under the care of Amanda Manley at the Cornwall Animal Hospital, who has been using Activon Tulle Manuka honey impregnated dressings to treat the wounds.

Amanda said: "I'd like to say it was all down to the manuka honey, although it's difficult to make a scientific judgement without a control in place. Nevertheless I am very impressed with the results and will definitely use honey again in a similar situation"

Rachel Fuller, Product Manager for Activon (medical grade manuka honey dressings) at Dechra Veterinary Products said: "In human medicine, manuka honey has become popular as a result of its antibacterial and healing properties. All honey has a degree of effectiveness, but the unique properties of manuka honey make it by far the most effective for use on wounds. It is now gaining recognition among veterinary professionals, which has led to the introduction of honey-based wound management systems for animal care".

According to Dechra, Manuka honey has been shown to be effective against over 70 strains of bacteria commonly found in wounds, including MRSA¹. It also has an osmotic effect which draws fluid from a wound bed and helps to remove slough and debride necrotic tissue that can harbour bacteria and impede wound healing². It protects the wound bed and provides a moist wound healing environment³ and the water soluble antioxidants provide favourable conditions that help to promote granulation and epithelialisation, thus faster healing. There is a rapid reduction in odour when honey is applied to a malodorous wound and it also acts as an anti-inflammatory, which therefore reduces pain.

The Cornwall Animal Hospital is a registered charity which exists to provide affordable pet care to those on a low income. It has provided all Lady's treatment at cost, including the Activon dressings, which have since been replaced by  Dechra as a gesture of support.

Photographs of the case at initial examination, post debridement / pre-treatment and post treatment are in the galleries.

References

• 1. Molan, P.C., The antibacterial activity of honey. Part 1. Its use in modern medicine. Bee World 1992; 80(2): 5-28
• 2. Molan, P.C., EWMA Congress, Glasgow 2007
• 3. Dunford, C., et al. The use of honey in wound management. Nursing Standard, November 2000; 15,11,63-68

Butternut Box, which makes fresh food for dogs, has launched a new referral scheme for veterinary surgeons. 

The company makes personalised, calorie-controlled fresh meals for dogs; 20 million of them since it launched in 2016.

Each recipe is made of human-grade ingredients and contains 60% single-source protein and 40% vegetables and lentils, with added minerals. There are no preservatives, derivatives or byproducts. Recipes such as "Chow Down Chicken," "Gobble Gobble Turkey," and "Swish Fish Dish" contain less than 5% fat content.

The meals are portioned specifically to each dog according to their calorific need. They are then delivered directly to the customer's door (free-of-charge) via a subscription model.

The model has proven so successful that Butternut Box has recently secured £20m in venture capital to grow the business.

The company launched a referral programme in early May, in which over 50 veterinary surgeons and nurses have signed up to become Butternut Box 'ambassadors'. 

Each ambassador is give a unique discount web address which they can give to any client that would benefit from a freshly cooked, calorie-controlled diet for their dog.

If the client redeems the code, a one-time referral fee is credited to the ambassador's account, which can be transferred to a personal account, donated to charity or spent on Butternut Box food for their own use.

Kyle Kennedy from Butternut Box said: "We take great pride in the quality of our food. We think dogs deserve better, and we want to give pet professionals a food they can be proud to recommend."

For more information about being a Butternut Box ambassador, email: kyle@butternutbox.com.

The RCVS Disciplinary Committee has suspended a veterinary surgeon formerly practising in Southampton for failing to make animal welfare his primary concern.

At a hearing this week, adjourned from September 2010, the Disciplinary Committee heard charges against Michael Albring, formerly of VetCall practice, Bitterne, Southampton. Mr Albring was said to have failed to make a home visit to attend Bear, a Newfoundland dog belonging to Mrs Thacker, when he knew, or ought to have known, that there were clinical or welfare grounds making a home visit necessary.

The hearing was held in Mr Albring's absence; the Committee considered that, having postponed the case last year at his request, Mr Albring had had ample time to prepare his case and submit any mitigations, and sufficient opportunity to attend. Additional adjournment would further delay the matter's resolution and not be in the wider interests of justice, or public confidence in either the RCVS disciplinary system or the veterinary profession.

On the evening of 19 December 2009, Mr Albring had been the veterinary surgeon on duty at VetCall, a practice that provides the out of-hours emergency cover for several local veterinary practices, including the one where Bear was registered. When Mrs Thacker's daughter, Ms Davidson, telephoned VetCall to request a home visit as the dog had collapsed, she was told that it was against practice policy for the practice to be left unmanned so this would not be possible. This was despite a written policy which accepted and made provision for the rare occasions when a home visit would be necessary. Phoning again later, the information about practice policy was repeated and Ms Davidson directed to a local animal ambulance service, which attended.

The ambulance driver found that the dog could not be transported in the ambulance and telephoned VetCall to say a home visit was needed. This was refused by Mr Albring even, the Committee noted, when the ambulance driver offered to collect Mr Albring, drive him to Ms Davidson's home 10-15 minutes away, assist with the euthanasia, and return him to the clinic. In the interim, Ms Davidson had also sought help from a separate practice and, subsequent to Mr Albring's refusal to visit, their on-duty veterinary surgeon attended and euthanased Bear. 

The Committee found that Mr Albring's refusal to visit, once it was clear Bear could not be transported, and he knew that a home visit was necessary on welfare grounds, resulted in Bear spending longer than necessary in pain and distress. This was not a case where the pressure of work or the welfare needs of other animals prevented Mr Albring from attending, and it was also relevant that Mr Albring was specifically employed to work out of hours in an emergency clinic. Serious, too, was his failure to reply promptly to communications from the RCVS, or show insight into the seriousness of his conduct.

In mitigation, the Committee accepted that this was an isolated case, and there were no previous findings against Mr Albring.  He was in sole charge of an emergency clinic covering 15-20 practices across Southampton and Portsmouth, which would make, in some circumstances, home visits difficult.

Professor Sheila Crispin, chairing the Disciplinary Committee, said: "The Committee is concerned that the actual policy pursued by the clinic regarding domiciliary visits was different to the written one.

"In effect, a no-visits policy existed at the VetCall clinic and this must have added to the pressure under which the Respondent [Mr Albring] was working.

"The Committee is mindful that the object of sanctions is not to be punitive, but to protect animal welfare, to maintain public confidence in the profession and to maintain appropriate standards," she continued, noting that as animal welfare had knowingly been neglected and Mr Albring had demonstrated no insight, a warning or reprimand would not be enough.  "A period of suspension would be sufficient to maintain public confidence in the profession and uphold standards," she said.

The Committee directed that Mr Albring's name be suspended from the RCVS Register of Veterinary Surgeons for ten months.

RSA Insurance Group, which underwrites pet insurance on behalf of MORE TH>N, Tesco Bank, M&S, John Lewis, Argos and Homebase, has clarified recently announced changes to its policy conditions concerning cases which need to be referred for specialist treatment.

In a letter dated 22nd May, which was sent to practices in the Midlands and the NW, the company said:

"With effect from the 25th May 2015, if you need to refer a pet under any of the above Brands to a specialist or referral vet, and the visit is not in response to an emergency, then our customer / your Client can contact us on the relevant number below before any appointment is made. We will then agree which of our preferred specialist or referral practices our customer should go to, dependant (sic) on the individual circumstance relating to the claim. If our customer does not get in touch with us or we have not agreed to the visit, then this could result in our customer suffering a financial impact. This amount will be in addition to the policy excess."

Speaking to VetSurgeon.org, Keith Maxwell, Head of Pet Claims at RSA said: "What we're saying to the primary practices is that we want to speak to our customers before they go to a referral vet. We want to engage with our customers to let them know that we have referral vets who we are starting to work with across those specific regions. We are not saying to customers that you have to use those referral vets and if you don't, we won't provide cover."

This appeared to contradict a statement that a member of VetSurgeon.org had received from John Lewis earlier which said: “If you decided to go to a specialist that wasn’t approved by us, we wouldn’t cover the costs." Keith said: "That is not correct."

Clarifying the financial impact referred to in the company's letter to veterinary practices, Keith said: "In terms of any sort of financial impact on the customer, if we think about the level of benefit that a customer will have under their insurance policy, they will have a maximum cash benefit. If a customer goes to one specific referral vet and the cost of treatment is extremely high, and they have a choice of going to a referral vet that we have been interacting with to get a like for like treatment, the cost will be lower, the financial impact on the customer will be that the overall benefit available to them will be eroded at a faster rate."

He added: "The other thing I would say is that certain customers under our policies will have a policy excess which will be on a percentage basis. Now if you think about a higher cost treatment which will incur a percentage excess, it will be a higher amount the customer will have to pay, as opposed to going to a referral vet where they can get the exact same high quality treatment, but the overall cost will be lower; they will pay a lower excess. So we are not saying we are going to penalise a customer. There are other financial consequences i.e. eroding benefit or having to pay a greater amount of excess."

Whilst RSA appears not to be removing the freedom of choice over referrals, there remains the potential for a conflict of interest when a primary practitioner recommends treatment at a centre they believe to be the most suitable for the case, and the client then rings the insurer only to be advised to use an alternative, primarily for reasons of cost. Keith said: "What I would say is that we are at the start of a journey. We've selected a small part of the country. We are very much in a 'test and learn' phase. As we have selected referral vets, we have gone through obviously quite a lengthy process of engaging with referral vets, looking at specialism, looking at their accreditation, looking at their capability, their skill, equipment within their practices, what their areas of specialism are, so we are building up this view. It does come down to we want to learn from this. We want to engage with our customers. We want to offer our customers choice. We want to make sure that our customers will not be receiving an inferior service or inferior treatment or level of specialism in any specific way."

VetSurgeon.org asked how RSA has selected its preferred referral practices, and how others can join its network. Keith said: "When we started this journey, we made contact with a significant number of referral vets across the country. Some referral vets just said point blank 'No, we don't want to talk to you'. Others said 'Yes, we'd like to come and have some discussions'. So we took those forward and then we took the referral vets through a benchmarking process based on a full list of criteria, and within RSA we have veterinary expertise helping us along that journey, so we're not just doing this on our own. We are very much an open door to interacting and liaising with referral vets."

Keith concluded by saying: "We are focused on our customers here. We are focused on making sure that pet insurance is sustainable in the long term, both for our customers and for vets across the country."

A joint statement issued by the RCVS and the BVA with updated guidance for the professions about working during the coronavirus pandemic has led to an outcry on social media and highlighted flaws in the structure of the veterinary profession. 

Earlier this month, the government had exempted veterinary surgeries from the requirement to close their doors during the pandemic. Strictly speaking, the exemption meant that practices could carry on offering the same level of service as before, provided they followed further government guidelines on social distancing.

However, the College then advised that non-essential treatments should not be carried out until further notice, and that animals should only be seen in emergency, or if their health was likely to deteriorate as a result of inaction.

This included vaccination, where RCVS advice stated that whilst routine vaccinations were considered not urgent, there "may be scenarios where, in your professional judgement, vaccines are being given to reduce a real and imminent risk of disease; this includes in the face of an animal disease outbreak, or in a scenario where part of a vaccine course has been given and the animal may be exposed to the disease." 

The updated College guidelines, issued last Thursday evening, appeared little changed, except to say that its advice concerning vaccinations is under review. Meanwhile, its new flowchart gives a very clear framework for veterinary professionals to work within, essentially leaving it to your own professional judgement to weigh up the risks.

However, the BVA went further, declaring amongst other things, that:

Vaccinations – we are now recommending that primary vaccinations and year 1 boosters in dogs and cats go ahead due to the increased risk of disease outbreak over a longer period of time, and annual leptospirosis vaccination due to the zoonotic risk. If additional component of the core vaccine is due at the same time, it should also be administered. In addition, we’re recommending rabbit vaccinations go ahead due to the seasonal disease risks. Rabies vaccinations should be carried out if required for certification reasons

.... leading to an outcry that the BVA's advice appeared to be being relaxed at precisely the point when the government is imploring the public to stay at home, and that:

• it must have been the result of pressure from corporate veterinary businesses which are taking a severe financial hit from the loss of vaccination sales,
• that it would lead to veterinary surgeons being forced by their (probably corporate) employers to work when they believe it is wrong to do so,
• that it would put unnecessary strain on practices that are struggling to look after urgent case with reduced staff,
• that it would lead to pressure from the public to carry out non-essential vaccinations,
• that it would cause Vesuvius to erupt and the oceans to boil.

To add further fuel to the flames, the British Small Animal Veterinary Association then issued a statement to the effect that it had not been consulted during the preparation of the new BVA guidelines, which BVA past President Robin Hargreaves felt was so economical with the truth that he resigned his BSAVA membership on the spot.

COMMENT
At the end of it all, there is but one simple truth for every veterinary surgeon who is working in these difficult times, and it is this: The government and the RCVS guidance gives you the freedom to exercise your professional judgement concerning whether or not an animal needs to be seen for whatever reason. Provided you can explain why you reasonably concluded that an animal should or should not be seen, that is all that matters. It trumps everything else.  

This whole farago has highlighted a number of important issues in the profession, starting with the social media conspiracy theories that the new guidance came after pressure from corporate practices when as far as I can tell, it appears to have been driven by a genuine concern that that failure to vaccinate could cause significant welfare issues in the future.

That seems a reasonable argument, and very much in line with the College advice. But that in turn raises a far bigger question, which is what on earth the BVA (a voluntary membership organisation) was doing issuing what appeared to be instructions ostensibly for all members of the profession. Notwithstanding the fact that BVA recommendations have no legal weight, having all these chefs running around with different recipe books is itself a recipe for muddled communications and confusion over leadership.

In turn, that raises the even bigger question of what the BVA's role should be. Should it be snuggling up in bed with the RCVS, issuing joint edicts? Or should it instead be holding the College to account, challenging its decisions and demanding clarification where clarification is necessary. I would argue the latter. In this situation, the ONLY organisation issuing guidelines about vaccinations for practising vets should be the regulator. And it is the role of the BVA to challenge those guidelines if necessary, or to demand clarification.

Which leads me on to the next thing, which is that increasingly, members of the profession seem to demand explicit rules or guidelines to operate within. There are lots of hypotheses for why this might be true. Perhaps because we live in a more (or seemingly more) litigious world and veterinary professionals like the reassurance rules provide. Perhaps it is because the younger cohort of vets lack the self-confidence needed for decision-making. Perhaps corporatisation has a part to play, in that employees of larger organisations tend to play more by the rules. Or perhaps it is a consequence of the growth in the 'refer everything’ culture which means vets take fewer clinical risks.  

Whatever the reason, it seems clear that in some cases, the RCVS tack of "you're a professional, decide for yourself" is perfectly reasonable, whereas on other occasions, such as Schedule 3, more explicit guidelines are demonstrably necessary. Once again, surely the role of the BVA as the "Voice of the profession” is not to issue its own advice, but to press the College for more explicit guidelines as necessary.

Lastly, there is the role of Facebook in all of this. Quite obviously vets are no more immune to conspiracy theories than members of the public who think that coronavirus is spread by 5G telephone masts. Sadly, the truth is usually far less exciting. However, the problem at the moment is that the growth in social media and Facebook groups has left the regulator and the representative associations on the back foot, such that it is often left to individuals from those organisations who 'happen to come across OK online' (rather than having any properly defined role) to firefight.

Photo: https://www.scientificanimations.com/wiki-images/