Musculoskeletal therapists currently have their work underpinned by an Exemption Order to the Veterinary Surgeons Act 1966 which allows them to treat an animal under the direction of a veterinary surgeon who has first examined that animal.
The College says it has recognised that there has been confusion over whether musculoskeletal therapists need a veterinary referral for maintenance work, such as massage, in a healthy animal. This may lead to delays in animals receiving maintenance care.
The new guidance, found in Chapter 19 (www.rcvs.org.uk/unqualified) of the supporting guidance to the Code of Professional Conduct, sets out the existing rules for musculoskeletal treatment of illness, disease or pathology, and clarifies that healthy animals do not need a veterinary referral for maintenance care.
The guidance stresses that musculoskeletal therapists are part of the vet-led team, and that any animal, including healthy ones, should be registered with a veterinary surgeon and referred to a vet at the first sign of any symptoms that may suggest underlying health issues.
The guidance also says that vets should be confident that the musculoskeletal therapist is appropriately qualified; indicators of this can include membership of a voluntary regulatory body with a register of practitioners, and associated standards of education and conduct, supported by a complaints and disciplinary process.
In March 2019 the RCVS published the Review of Minor Procedures Regime (www.rcvs.org.uk/document-library/report-to-defra-on-the-review-of-minor-procedures-regime-and/) which noted that the existing exemption order was not suitable for underpinning the work of musculoskeletal therapists, and recommended that this be remedied by reform of Schedule 3 of the Veterinary Surgeons Act, alongside regulation by the RCVS through Associate status for musculoskeletal therapists.
This would allow the RCVS to set and uphold standards for musculoskeletal therapists in a similar way to veterinary nurses, giving further assurance to both the veterinary professions and the public. The recent Legislation Working Party Report recommendations builds on that recommendation, and is currently open for consultation at www.rcvs.org.uk/consultations
The Disciplinary Committee has directed that Kfir Segev be restored to the RCVS Register, having removed him over two years ago for dishonesty and misleading clients.
Mr Segev, formerly practising in Stanmore, Middlesex, was removed from the Register following an 11-day hearing ending on 19 May 2009 at which he had been proven guilty of deliberately concealing from his clients that their dog was terminally ill, whilst at the same time recommending that she undergo expensive and unnecessary procedures.
This was Mr Segev’s first application for restoration to the Register. The Committee found that, during his period of removal, he had undergone “extensive personal and professional rehabilitation”, which included attendance at a clinical psychologist and voluntary work in the local community.
The Committee found that, during his period of removal, he had undergone "extensive personal and professional rehabilitation.
From 2009 to September 2011, Mr Segev logged 420 hours of certificated continuing professional development, with particular emphasis on ethics, client relationships and animal welfare.
The Committee noted he had also seen practice and taken the advice of mentors, including about 80 days at “a number of high quality practices with eminent members of the profession”.
These included Professor Dick White MRCVS, of Dick White Referrals, Professor David Noakes FRCVS, Emeritus Professor of the Royal Veterinary College and Mr David Grant MBE FRCVS, Hospital Director at the RSCPA Sir Harold Harmsworth Memorial Hospital, all of whom gave evidence at the hearing in support of Mr Segev.
Professor White said that, since late 2009 when he was approached by Mr Segev for help in remedial training, continuing education and mentoring, he had subsequently had frequent dealings and conversations with him.
Professor White said: “I formed the opinion that he invariably exercised professional clinical judgement that is, if anything, considerably deeper than many professional colleagues. I felt he demonstrated compassion for patients and empathy for owners in equal measure and believed him to have come to understand fully the seriousness of his behaviour."
Mr Segev’s efforts at rehabilitation were described as “exceptional” by Professor Noakes, who said he was “impressed by Mr Segev’s genuine acceptance of the fact that he had committed a serious offence and deserved to be punished.”
Mr Grant, who had been in contact with Mr Segev since November 2010, told the hearing that, in his opinion, it was most evident that Mr Segev accepted his wrongdoing and, along with Professor Noakes, indicated that he was willing to offer continued support and help.
The College opposed the restoration of Mr Segev on three grounds, namely: the gravity of the matters found proved at the original hearing; that the length of time off the Register was insufficient to mark these and ensure that the reputation of the profession was not undermined in the eyes of the public; and, Mr Segev’s conduct, relying on two matters arising from the footage in a BBC Panorama programme, which was filmed both before and after the 2009 hearing.
The College also questioned whether Mr Segev genuinely accepted the original findings.
The Committee agreed that the findings of the original hearing were serious; it was, however, impressed by Mr Segev’s complete and genuine written and public apologies for what he had done.
It disagreed that the length of time off the Register was too short.
It was mindful that the purpose of the sanction of erasure is not primarily of punishment and considered that no useful purpose would be served by delaying further Mr Segev’s restoration.
Whilst the Committee found Mr Segev was wrong to have continued to display ‘veterinary surgeon’ on the practice nameplate (as shown in the television footage), it was satisfied that he did not intend to hold himself out as a practising veterinary surgeon and no harm to the public or animal welfare resulted from his mistake.
The footage also showed Mr Segev was in breach of RCVS guidance on the administration of anaesthesia by permitting a student veterinary nurse to induce anaesthesia by using incremental doses of intravenous propofol, with an unqualified assistant offering advice on the depth of anaesthesia during its incremental induction. The Committee considered Mr Segev’s actions to be an error, now cured.
In conclusion, the Committee accepted Mr Segev “had made genuine and successful attempts to reform his previous attitude and failings”.
It noted that a large number of testimonials had been provided by colleagues, friends and clients, and that the impact of removal on Mr Segev had been severe.
It concluded that his previous mistakes provided “no reason, relevant to animal welfare, to suggest that his restoration would be unwise.”
Speaking on behalf of the Committee, Chairman Beverley Cottrell said: “Restoration to the Register of a veterinary surgeon who has been guilty of disgraceful conduct in a professional respect of such seriousness is not something to be undertaken lightly … But, in all the circumstances of this case, [we have] decided that Mr Segev is a fit person to restore to the Register, and so direct the Registrar.”
David Chalkley MRCVS faces four alleged charges:
At the start of the hearing Mr Chalkley made no admissions as to the charges but he had made an application for an adjournment based on undertakings to remove himself from the Register and never to apply to be restored to the Register.
In addressing the Committee on behalf of Mr Chalkley, his counsel said that Mr Chalkley denied all charges of dishonesty, that there was no evidence of harm to animals as a result of the alleged conduct, that there had been no complaint from the client and that he had repaid all the sums he had received for tuberculin testing on the farm in question.
His counsel also submitted that a full hearing would be expensive and time-consuming, and that it would serve no useful purpose as animal welfare and the protection of the public would be served by Mr Chalkley’s proposed undertakings.
Counsel on behalf of the RCVS confirmed that the College did not oppose the application and confirmed that the Animal Plant and Health Agency did not object.
However, the Disciplinary Committee concluded that because the case concerned issues of alleged dishonesty in veterinary certification over a prolonged period of time and the importance of public trust in the accuracy and reliability of that process, there was a need to hold a full, public hearing into Mr Chalkley’s alleged conduct.
Ian Arundale, chairing the Committee and speaking on its behalf, said: “The Committee expressed no view as to whether the allegations could be substantiated or not and it recognised that the process of determining the allegations would be burdensome for many, particularly the respondent.
"It was satisfied, however, that a reasonable and fully informed member of the public would be disturbed to learn that allegations of this kind had not been the subject of a formal determination by the Disciplinary Committee. The respondent’s own interests had to take second place to this important public interest.
“The Committee therefore declined to accept the application to adjourn this inquiry [until an unspecified date] and directed that arrangements should now be considered for the listing of a hearing in this case.”
It is expected that the full hearing will take place in spring 2021.
First prize went to the University of Edinburgh’s Molly Vasanthakumar (pictured right) for her Knowledge Summary comparing the ecological impact of woven versus disposable drapes. Molly found that there is not enough evidence that disposable synthetics reduce the risk of surgical site infections when compared to reusable woven drapes, based on her assessment of the available literature.
Molly said: “The Veterinary Evidence student competition gave me an opportunity to identify a specific issue, find and appraise the evidence and then apply it to a practical setting.
"Winning the competition has given me a chance to further my skills in evidence-based veterinary medicine [EBVM] and also raise awareness of an incredibly important and topical issue."
Molly received her prize at RCVS Day, and her published paper can now be read in Veterinary Evidence: http://bit.ly/MollyVasanthakumar
Second prize went to Honoria Brown of the University of Cambridge, whose paper asked: "Can hoof wall temperature and digital pulse pressure be used as sensitive non-invasive diagnostic indicators of acute laminitis onset?"
Honoria said: "Writing this Knowledge Summary was the perfect chance, not only to develop my ability to navigate and analyse databases, but also to present my findings for the benefit of other clinicians who face these issues.
"I feel that these skills will be very useful to me later in my career, and I am grateful to Veterinary Evidence for providing me with the opportunity."
Jacqueline Oi Ping Tong from the University of Edinburgh won third prize for her critical appraisal of the evidence for whether a daily probiotic improved clinical outcomes in dogs with idiopathic diarrhoea. She said: "This experience makes me recognise the importance of evidence-based veterinary medicine to the veterinary community; it connects scientific research to everyday practice.
"It was a great opportunity to engage in EBVM early in my veterinary career, and start learning how to critically appraise the current evidence."
Jacqueline and Honoria’s Knowledge Summaries have been accepted for future publication in Veterinary Evidence.
All submissions were subjected to the same standards and peer-review process as normal journal submissions.
RCVS Knowledge’s Executive Director, Chris Gush, said: "EBVM and its application into practice starts as part of the undergraduate degree, and we are delighted to encourage and champion student involvement.
"This new initiative from our journal taps into the student body’s potential to help grow the evidence base, whilst preparing the next generation of veterinary professionals for when they graduate."
The Veterinary Evidence Student Awards are running again for 2020 and are open for submissions.
The awards are open to all undergraduates studying veterinary medicine, veterinary nursing or bioveterinary science (and equivalent). More information can be found here: http://bit.ly/VEstudentawards
Neurodiversity Celebration Week is a worldwide initiative that challenges stereotypes and misconceptions about neurological differences, and the neurodiversity resource hub (www.vetmindmatters.org/resources/) aims to help members of the veterinary professions better understand how, for over one million people in the UK, neurological differences mean they learn and think in a way that is different to what is considered ‘neurotypical’.
Among the resources contained in the hub is information about neurological conditions closely associated with neurodivergence such as attention deficit hyperactivity disorder (ADHD), autism, dyspraxia and dyslexia, as well as information for employers about neurodiversity, including inclusive working tools and sources of government support.
A new ‘kite’ with six new modules are also being added to the MMI Kite App – a specialist microlearning platform for topics related to veterinary wellbeing – that deal specifically with issues related to neurodiversity. The six modules cover: what is neurodiversity; the importance of talking about neurodiversity; different types of neurodiversity; bespoke considerations for neurodivergent individuals; how neurodivergence can lead to innovation through thinking differently; and, exploring further how different brains work and how we can make our brains work best for us.
The College is also publishing a blog on the resource website by Dr Kirstie Pickles, Clinical Assistant Professor in Equine Medicine at the University of Nottingham, about her current MMI-funded research investigating the various workplace stressors that affect autistic veterinary professionals and what adjustments can be introduced to mitigate these stressors.
Lastly, at BSAVA Congress on Saturday 26 March between 3pm and 4pm, the RCVS has organised a discussion session on neurodiversity.
The discussion will be led by Roxanne Hobbs, a consultant in workplace inclusion particularly around neurodiversity, and will look at how to nurture and cultivate neurodiversity in the veterinary professions.
Lisa Quigley, Mind Matters Manager, said: “As a project focused on the mental health and wellbeing of veterinary professionals, the Mind Matters project has a commitment to recognising and providing a space for all forms of diversity, and so we are very glad to be supporting Neurodiversity Celebration Week again this year.
“We hope that our neurodiversity resource hub and our other initiatives during Neurodiversity Celebration Week will be useful source of information for everyone and will aid people in understanding neurodivergence, how it can manifest and how it can be supported in the workplace and educational settings.”
The RCVS Disciplinary Committee has removed a veterinary surgeon formerly working in Lincolnshire from the Register, after finding him guilty of serious professional misconduct for drink-driving related convictions, failing to inform his employer of these convictions, and driving whilst disqualified.
Jaroslaw Slominski, a former employer of Grants Veterinary Services plc, chose not to attend the three-day hearing. The Committee considered whether to proceed with the case, using criteria identified by the Court of Appeal in R v Jones (Anthony) in 2002 and confirmed by the House of Lords. It concluded it was in the interests of justice that the hearing should go ahead.
The charges related to two convictions Mr Slominski received on 17 March 2010 at Lincoln Magistrates Court: failure to provide a specimen of breath for analysis and driving without due care and attention (after his vehicle collided head-on with another car). Mr Slominski failed to inform his employers of these convictions, as he was contractually obliged to do, and that he was now disqualified from driving.
Having heard evidence from Mr Slominski's line manager, the Committee also found that he had driven his employer's vehicle whilst disqualified, although it could not be sure that he had done so on all the occasions alleged. Therefore, the Committee did not go on to consider an alternative part of the charge - that Mr Slominski had dishonestly claimed money from his employer by falsely submitting expenses claims.
Disciplinary Committee Chairman Prof Peter Lees said: "The combination of factors in this case, namely, the serious nature of his conviction in failing to provide a specimen of breath, his subsequent premeditated conduct in not informing his employers and driving whilst disqualified should be treated by the profession very seriously. The Committee has concluded that the combination of the conviction and the conduct is incompatible with Mr Slominski practising as a veterinary surgeon."
The Committee directed that Mr Slominski's name be removed from the Register.
RCVS CEO Lizzie Lockett said: "I am so proud of our performance in the Great Place to Work Awards and the efforts of everyone at the College, and especially our HR team, who have been tirelessly and creatively striving to make the College a wonderful place to work.
"Consistently being placed in the top 50 Great Places to Work is also a testament to the sustained hard work all of our employees and the important part they play in creating a supportive, interesting and good-humoured workplace.
"We are a service-led organisation and we want to make sure that we give our best to the veterinary professions and the general public. If our team enjoys the work, and the workplace, that will improve the service we are able to offer and, ultimately, benefit animal health and welfare."
The RCVS is inviting responses from veterinary surgeons, veterinary nurses and animal owners to a call for evidence on the provision of 24-hour emergency veterinary care, in order to understand how best to meet the expectations of all those involved.
In an open letter to the profession and the public published on the RCVS website, the Chairman of the RCVS Standards Committee, Clare Tapsfield-Wright, said:
"Over the past two years, lay people working with the RCVS have raised questions about the veterinary profession's ability to provide 24/7 to the extent required by the RCVS Code of Professional Conduct, and said there is a disconnect between the public's expectations and the profession's capacity to meet those expectations."
Clare also refers to an RCVS Disciplinary Committee Inquiry in June 2013, which raised a number of issues on home visits by veterinary surgeons, including: speed of response; travelling time and distance; daytime versus out-of-hours obligations; individual versus corporate responsibility; and, staffing levels and contingency plans.
The letter is accompanied by a range of background information, including the reports of Lay Observers to the RCVS Preliminary Investigation Committee; Working Party reports from the College's 2009 consultation on 24-hour emergency cover; and, further details about the June 2013 DC Inquiry.
The College says additional feedback will be sought through next year's RCVS Survey of the Professions, and via focus group research for animal owners. Once all responses have been collated, a number of individuals and organisations will be invited to a Standards Committee meeting to present and discuss their views.
Responses in writing are invited by 5pm on Monday, 17 February 2014, and should be emailed to 24-7@rcvs.org.uk or posted to the Professional Conduct Department, Royal College of Veterinary Surgeons, Belgravia House, 62-64 Horseferry Road, London SW1P 2AF.
The consultation, which was held by the College early in 2017, asked for the views of veterinary surgeons and nurses, animal owners, and stakeholders on the use of telemedicine in veterinary clinical practice.
The consultation was designed to help identify potential risks associated with telemedicine, identify areas where it may help address the needs of both clinicians and the public, and support the potential development of new professional standards and guidance.
The online survey of veterinary professionals received 1,230 responses, while the public consultation received 229 responses and the survey of organisations/stakeholders received eight responses.
The headline question asked of veterinary professionals was whether RCVS 'supporting guidance to the Code of Professional Conduct' should be amended to allow remote examination to take the place of physical examination in certain circumstances. 41% said 'Yes', 40% said 'No' and 18% were unsure.
Veterinary professionals and organisations were then asked a series of questions in order to establish how they rated the risk associated with telemedicine according to activity type, practice type, clinical sign or syndrome, mode of technology, and familiarity with client, animal or environment.
Unsurprisingly perhaps, the majority felt that providing just general advice presented a low risk. At the other end of the scale, most felt that the use of telemedicine to diagnose disease or injury would be either 'high risk', or 'not appropriate at all'.
Likewise, the majority said the risks would be low or medium where the client and environment were known and the animal seen before, for the same problem. By contrast, the majority said telemedicine would be either 'high risk' or 'not appropriate at all' when the client, animal and environment were all unknown.
When asked whether the current definition of 'under care' should be extended to allow veterinary surgeons to prescribe veterinary medicines where there has been no physical examination of the animal, 69% said 'No', 16% said 'Yes' and 15% were unsure.
However, when asked whether certain types of veterinary medicines should be able to be prescribed without a physical examination of the animal, the majority of respondents to the professional survey (52%) were in favour.
The results of the consultation were first considered at a special meeting of the Standards Committee in August 2017, where it was noted how the consultation had revealed significant confusion around current supporting guidance to the RCVS Code of Professional Conduct and that, at a minimum, clarification as to what was currently permissible was needed.
The Committee determined a key issue going forward was whether to change the Supporting Guidance to the RCVS Code of Professional Conduct regarding 'under care' to allow veterinary surgeons to prescribe POM-V medicines based on telemedicine alone.
Given the complex nature of the issues and the wide-ranging implications, the Standards Committee presented a range of options for amending RCVS Guidance to RCVS Council at its meeting in November 2017. After discussion, Council asked the Standards Committee to continue their review and to present more detailed proposals to Council regarding the future of telemedicine in clinical veterinary practice.
Anthony Roberts, RCVS Director of Leadership and Innovation, said: "We would like to thank all those who took the time to respond to the consultation – although Council has not yet made any firm decisions, we felt it would be useful to share our research so far.
"The use of telemedicine is growing rapidly in human healthcare and it is only right the RCVS assesses the opportunities it could bring to improve access to veterinary services. It is critical, however, that we understand the issues it presents 'at the coal face' and consider all the available evidence before making any changes to our Guidance. The RCVS should ensure its regulatory framework fosters innovation and maximises the opportunities to improve the quality, efficacy and accessibility of veterinary services, whilst at the same time protecting animal health and welfare."
The Standards Committee will meet again in April 2018 to take further evidence and develop proposals to take the issue forward.
Meanwhile, the full summary is available on the College’s website: www.rcvs.org.uk/telemeds-summary/.
During the webinar, which took place earlier this month, senior officers and staff from the College explained the new guidance, what it will mean for the profession, and answered questions submitted by delegates.
The webinar was chaired by RCVS President Dr Melissa Donald MRCVS with a panel comprising Standards Committee Chair Linda Belton MRCVS, RCVS Registrar Eleanor Ferguson, and RCVS Head of Standards Gemma Kingswell.
The webinar included an overview of the main changes, the considerations to take into account when prescribing POM-Vs remotely, the circumstances under which POM-Vs cannot be prescribed remotely, the prescription of antibiotics, antifungals, antiparasitics and antivirals, and how the guidance will be enforced.
Eleanor Ferguson, RCVS Registrar, said: “We have also now published a range of practice-based scenarios to help explain how the new guidance should be followed in various circumstances, and in relation to different species.
"These scenarios cover a variety of different situations, including how the guidance applies to two or more practices with mutual clients, consultancy services and the prescription of long-term controlled drugs.”
A second webinar will be held on Monday 17th July, with priority for those who wanted to attend the June webinar but were not able to do because it was over-subscribed.
www.rcvs.org.uk/undercare
Currently Principal of the Royal Veterinary College, University of London, and previously Dean of the University of Glasgow’s School Of Veterinary Medicine, Stuart has been a member of RCVS Council since 2005, and served as RCVS President in 2014-15.
As chair of the Education Policy and Specialisation Committee in 2011, Stuart oversaw the College’s review of veterinary specialisation, which also led to the new Advanced Practitioner status.
He has also been a driving force behind the joint RCVS and BVA Vet Futures project since its inception in 2015.
As Chair of the RCVS Governance Panel, he recently saw through reform of the College’s governance arrangements to improve the efficiency and accountability of its decision-making processes.
Stuart has also chaired the RCVS Science Advisory Panel.
He continues to chair the College’s Mind Matters Initiative, which aims to improve the mental health and wellbeing of all those in the veterinary team.
A particularly notable achievement during his Presidential year was to allow UK veterinary surgeons to use the courtesy title ‘Doctor’ if they so wished.
Lizzie Lockett, RCVS Chief Executive said: "We have been incredibly fortunate to have someone of Stuart’s calibre, character and international renown on our Council for so many years. His contributions and commitment to the RCVS, as well as to the wider veterinary professions, are as significant as they are often understated.
"On behalf of RCVS Council and all the staff, I should like to say how delighted we are that he has been honoured in this way. Such recognition is very much deserved and we send him our warmest congratulations."
Ms Mulvey faced a number of charges relating to the treatment of a cat called Spooky: that she failed to provide Spooky’s owner, Mrs Parsons, with either Spooky’s lab results or an adequate explanation as to why they could not be provided; that she failed to respond adequately or at all to communications from Mrs Parsons; that she failed to respond to requests from the College for information relating to Continuing Professional Development (CPD), her professional indemnity insurance (PII), and her correspondence with Mrs Parsons.
At the beginning of the hearing Dr Mulvey admitted the facts to all the charges, and accepted that they constituted disgraceful conduct in a professional respect. The Committee had been provided with written evidence from Mrs Parsons, her husband, and four College staff, namely Gemma Crossley, Maria Fearon, Robert Girling and Michael Hepper.
Mrs Parsons provided a statement in which she spoke of how, in August 2016, she had taken Spooky to CornYard Veterinary Centre for a skin irritation where she was seen by Dr Mulvey.
Dr Mulvey decided to take blood tests and send them to the laboratory, but they agreed to defer them actually being tested until Mrs Parsons gave permission. Mrs Parsons then returned to the practice with Spooky to take said samples, after which followed a series of attempts to contact Dr Mulvey for the test results. Finally, in October, she demanded a refund, after which she began a small claim in County Court.
Mr Parsons went to the practice at the beginning of December 2016 and obtained the refund. At this point Mrs Parsons made a complaint to the College. The Committee received information from Mr Parsons, who corroborated the facts of the complaint, and from College staff who confirmed the many attempts to contact Dr Mulvey, starting with requests for documents by Ms Crossley and Ms Fearon, repeated requests for CPD and PII information from Mr Girling, and finally a hand-delivered letter by Mr Hepper, during which he learnt that her PII had lapsed at the beginning of 2017.
The College submitted that Dr Mulvey’s conduct fell far below the standard expected of a veterinary surgeon. It submitted that failing to provide the test results and communicate with the Parsons could have had a negative impact on animal welfare and damaged the reputation of the profession, while having PII is a fundamental obligation of the RCVS Code of Professional Conduct. Finally, not responding to the College about the concern raised, CPD or PII compromised the College’s ability to maintain public confidence in its regulatory processes.
The Committee considered that no harm had actually come to Spooky and that there were problems with the testing laboratory which slowed down the process. In addition, some of the lack of communication was due to a receptionist not following protocol, and Dr Mulvey was going through a particularly difficult part of her life and was clinically understaffed. The Committee heard from four different character witnesses, and were given 16 more written testimonials.
The Committee heard that in 2013 there had been complaints from three separate clients, all of which concerned Dr Mulvey’s failure to communicate and to process insurance claim forms, after which she agreed to participate in the Performance Protocol and entered into undertakings with the College.
The Committee having considered all the facts and background circumstances found that Dr Mulvey’s conduct was disgraceful in a professional respect.
The Committee went on to consider what sanction was appropriate. In reaching its decision the Committee took into account a number of aggravating factors, namely that there was a slight risk to the health of Spooky and that the disgraceful conduct occurred over a prolonged period of time. The Committee also considered that there was blatant disregard of the role of the RCVS and the systems regulating the profession.
In determining the sanction the Committee also considered mitigating factors, including that Dr Mulvey, apart from those previous concerns, had a long and unblemished career and that she’s made a huge difference to the health of the animals within her care. She also admitted her shortcomings, and had very impressive references.
The Committee therefore determined to postpone its decision on sanction for a period of one year on condition that Dr Mulvey enter into the following undertakings:
To agree to the appointment of a veterinary surgeon as a work place supervisor by the College and meet with them at least once every month
Allow the supervisor access to all aspects of running of the practice and to implement any recommendations made by the supervisor relating to the administration of the practice and the provision of out of hours’ cover.
To allow the supervisor to provide a report in relation to the matters set out in 2 above to the RCVS at least one month before the resumed hearing of this case.
To appoint within two months an experienced Practice Manager (who does not need to be full time).
To enrol in the voluntary Practices Standards Scheme and to achieve the Core standards of the Scheme within the next 12 months.
To submit a plan to the supervisor of CPD for the next twelve months within one month of agreeing to these undertakings. The plan should then be implemented and shall include aspects of practice management.
To pay all of the costs of complying with the undertakings, with the exception of the costs associated with the appointment and performance of the supervisor.
Ian Green, chairing the Disciplinary Committee and speaking on its behalf, said: "The Committee recognised that Dr Mulvey has been subject to undertakings before and yet committed the disgraceful conduct the subject of this inquiry. But it bore in mind the context of that conduct and it observes that the undertakings previously imposed in reality address a particular aspect of her practice.
"This Committee hopes that when the matter is relisted before it, the Respondent will be able to demonstrate that she has finally been able to address her administrative shortcomings. If she cannot do so, she will know that the Committee that sits on her case at the resumed hearing is likely to have more restricted options for disposal of her case."
The Disciplinary Committee heard three charges against Dr Jones.
The first and second charges were that, in March 2018, Dr Jones made signed entries in the passports and made corresponding entries in clinical records of four horses indicating that he had administered an influenza vaccination booster to each horse on 15 March 2018 and in relation to another horse a tetanus booster, when in fact he had administered the vaccination boosters on 21 March 2018, and that his conduct was misleading, dishonest and undermined the integrity of a vaccination process designed to promote animal welfare.
The third charge was that, on or around 21 March 2018, Dr Jones failed to make any entries in the clinical records for a horse in relation to an examination on 21 March 2018.
At the outset of the hearing Dr Jones admitted the facts in the first and second charges, and accepted that his actions were misleading, dishonest and that they undermined the integrity of a vaccination process. However, he disputed certain aspects of the written statements of the College’s witnesses. In particular he wanted his conduct to be taken in the context of the pressures that he was working under on that day, primarily that he was in a stressed state having had to euthanase a valuable stallion at the conclusion of his previous client appointment.
Dr Jones did not admit the third charge, explaining that he did not remember examining the horse on 21 March 2018 as alleged.
Based on Dr Jones' own admissions, the Committee found the first and second charges proven.
Regarding the third charge, the Committee heard evidence from the horse’s owner who said they were present during the examination taking place and the Committee was satisfied that the respondent did examine the horse on 21 March 2018 and that he had a duty to make a brief clinical note on the examination. As Dr Jones admitted that he made no such note, the Committee found the charge to have been proven to the requisite standard.
Having found the charges proven, the Committee then went on to consider whether or not Dr Jones’ proven conduct amounted to serious professional misconduct. The Committee, having considered the aggravating and mitigating factors, found that Dr Jones’ conduct as found proved in relation to both charges one and two, did constitute serious professional misconduct.
However, with regards to charge three, the Committee accepted that the respondent simply forgot that he had examined the horse and, therefore, the Committee was not satisfied that the failure to compile a record entry covering the horse’s examination constituted serious professional misconduct.
The Committee then considered what sanction to impose on Dr Jones in relation to the facts found proven in charges one and two. In doing so it took into account the 78 written testimonials and 4 character witnesses called on behalf of Dr Jones.
Ian Green, who chaired the Committee and spoke on its behalf, said: "The Committee’s decision on sanction has been based on an acceptance that the respondent’s conduct on this occasion was out-of-character, as the evidence of his character witnesses and the contents of the letters submitted in his support by his clients and other veterinary colleagues assert. The Committee also accepts that the respondent self-reported himself to his employer and to the College and has made a full and frank admission of his wrongdoing.
"Consideration was given to whether the sanction of a reprimand and/or warning as to future conduct would adequately reflect the gravity of the misconduct, however, after careful reflection it was concluded that such a sanction could not be justified. The reason is that acts of falsification involve acts of dishonesty by a professional person acting in a professional capacity, and the gravity of the matter arises not simply from the dishonesty but also from the possible consequences of the false certification. It should be clearly understood by members of the veterinary profession that, in appropriate false certification cases, the sanction of removal from the Register is one which may well be imposed."
The Committee therefore decided that suspending Dr Jones from the Register for two months would be the most appropriate sanction.
Fourteen veterinary surgeons stood for election this year and 8,542 voted, a turnout of 24.5% of eligible voters. That compares with a turnout of 26.2% in 2020, 25.5% in 2019 and 22.7% in 2018.
Danny scored a total of 4,759 votes, leaving the other successful candidates Tshidi Gardiner, Colin Whiting and Louise Allum nevertheless trailing in his wake, with 3,228 votes, 2,957 votes and 2,368 votes respectively.
The VN Council election also had fourteen candidates standing for one elected place, the other having been taken by Susan Howarth RVN who was automatically re-elected as the only candidate standing at the time of the original deadline in January.
Donna Lewis was elected with 404 votes from those cast by 2,341 veterinary nurses, which amounted to a turnout of 12.4% of eligible voters. That compares with a turnout of 17.1% in 2020, 14.5% in 2017 and 10.9% in 2016.
All of those elected to either RCVS or VN Councils will formally take up their seats at the RCVS Annual General Meeting on Friday 9 July 2021.
Eleanor Ferguson, RCVS Registrar and Returning Officer for both elections, said: “Thank you to all those who stood as candidates and all those who voted in this year’s elections, especially in view of all the extra demands on everyone’s time at the moment. Many congratulations to our five successful candidates with whom we look forward to working over the coming months and years.
“Even though the elections were held during the ongoing pandemic, the RCVS Council election still produced the third highest turnout on record, and turnout in both elections was above the average for those held over the last ten years.
“As always, we made concerted efforts to let people know about this year’s election, which included additional reminder emails sent on behalf of the RCVS by our election provider Civica Election Services, as well as regular email reminders and social media posts from the RCVS. We do, of course, always endeavour to improve turnout, and will continue to review this going forward.”
Photo: Left to right, Danny Chambers, Tshidi Gardiner, Colin Whiting and Louise Allum.
Mr Antonovs faced three charges.
The first was that in September 2020 whilst in practice at Beverley Vets4Pets, he attended work when under the influence of alcohol.
The second was that between September and December 2020, whilst at Peel Veterinary Clinic, he attended work on two occasions when under the influence of alcohol.
The final charge was that between February 2021 and February 2023, Mr Antonovs failed to respond adequately to requests from the RCVS regarding concerns raised about his conduct and/or health.
Mr Antonovs admitted the facts of the charges and the Committee decided that the facts amounted to serious professional misconduct.
The Committee therefore decided, in the particular circumstances of this case, to impose a reprimand and warning as to his future conduct on the basis that it would be proportionate in order to maintain public confidence in the profession and uphold proper standards of conduct and behaviour.
The full details of the hearing and the Committee’s decision can be found at www.rcvs.org.uk/disciplinary
At his first Disciplinary Committee hearing in January 2018, the Committee directed that Dr Gerhard Schulze Allen’s name be removed from the Register after finding him guilty of serious professional misconduct in respect of four charges against him. These related to an incident of petty theft in California in the United States, and his subsequent dishonesty in not disclosing this to the College.
Following the Disciplinary Committee hearing, Dr Schulze Allen submitted an appeal to the Privy Council. In July 2019, the Privy Council partially upheld his appeal, determining that the RCVS had not proven beyond all reasonable doubt that Dr Schulze Allen’s infraction for petty theft was a conviction under Californian law and therefore Dr Schulze Allen had not made false representations to the College when he said he did not have any criminal convictions or a criminal record.
However, the Privy Council partially upheld the College’s charge that Dr Schulze Allen was dishonest and made false representations when he had, in a written application for restoration to the Register, represented that he did not have any adverse findings and that he should have declared his infraction for petty theft. The Privy Council also set aside the Disciplinary Committee’s original sanction and remitted the task of sanction back to the Disciplinary Committee.
As a result of the Privy Council’s decision, the Disciplinary Committee held a further hearing in relation to Dr Schulze Allen to decide the sanction in relation to the upheld charge against him.
The Committee noted that the aggravating factors were the fact that Dr Schulze Allen was dishonest to his regulator and in making a false declaration, demonstrated a wilful disregard for the regulatory role of the RCVS. In mitigation the Committee considered that there was no harm to animals, that it was a single and isolated incident in an otherwise unblemished career, and that he had accepted his wrongdoing, albeit at a late stage, and was developing some insight.
The Committee considered whether a reprimand or warning would be the most appropriate sanction but determined that this would not reflect the seriousness of the dishonesty in this case, nor maintain public confidence in the profession or uphold proper professional standards of conduct and behaviour.
Ian Green, chairing the Committee and speaking on its behalf, said: "The Committee concluded that the appropriate and proportionate sanction is suspension from the Register for a period of three months. A period of three months reflects the seriousness of the charge. Such a sanction sends a clear message to Dr Schulze Allen, the profession and the public that behaving dishonestly towards the regulator is a serious matter. The Committee considered that removal from the Register would be disproportionate given that this is a single incident and Dr Schulze Allen now accepts his wrongdoing."
NOAH's third Brexit Barometer found that where in the last report, 17% of its members reported feeling 'very' or 'somewhat pessimistic', that figure has now risen to 32%.
Meanwhile, the National Audit Office has revealed in its 'Progress in Implementing EU Exit' report that Defra has been prevented from consulting with the veterinary market by DExEU.
The report states that Defra is one of the government departments most affected by EU Exit and looks in detail at four of Defra’s main workstreams, including ‘import of animals and animal products’ and ‘exports of animals and animal products’.
In an accompanying press release, the National Audit Office notes that in a no-deal scenario there will be a significant increase in certificates needing to be processed by veterinary surgeons. It says: "Without enough vets, consignments of food could be delayed at the border or prevented from leaving the UK. Defra intended to start engaging with the veterinary industry in April 2018, but has not been permitted to do so and now plans to launch an emergency recruitment campaign in October to at least meet minimum levels of vets required. It plans to meet any remaining gaps through the use of non-veterinarians to check records and processes that do not require veterinary judgement."
The BVA says it has previously outlined concerns about the potential for diluting veterinary certification, and is calling on the Government to fully engage with the veterinary profession before making any changes that could impact the UK’s ability to trade animal products safely and in line with high animal welfare standards.
The RCVS has also weighed in. Amanda Boag, RCVS President, said: "We are glad to see the National Audit Office report recognises that a ‘no deal’ Brexit scenario would be likely to reduce the supply of EU veterinary surgeons to the UK and cause uncertainty regarding the status of those EU veterinary surgeons who are currently living and working in the UK and that this would have a particularly serious impact on necessary veterinary work in public health and certification.
"We continue to engage with Defra and, like the BVA, we want to emphasise the essential need for Government to consult with the profession to ensure their plans meet requirements, including maintenance of the high veterinary standards for which the UK is known. We also want to highlight the importance and value of the veterinary profession in other areas of society including caring for pets, horses and farm animals as well as research, education and industry, and emphasise the impact of workforce shortages on all sectors."
The RCVS Disciplinary Committee has dismissed a case against Duncan Davidson MRCVS, a South London veterinary surgeon accused of clinical failings in relation to his treatment of a cat and of keeping poor and misleading clinical records.
The Committee heard the case against Dr Davidson, who was the sole practitioner and owner of Mitcham Veterinary Clinic until his retirement from clinical practice in November 2014, at a hearing which concluded on 22nd January.
The first charge against Dr Davidson alleged that, between 7 November 2013 and 13 December 2013, he had failed to provide adequate care to Ameira, an Egyptian Mau cat. The charge was in four parts: that he had inappropriately administered corticosteroids; had failed to administer adequate fluid therapy; discharged the cat to its owner suggesting a referral when he should have suggested or arranged a same-day referral; and that he failed to communicate the urgency of referral/ further investigation of the cat’s condition to her owner.
The second charge was that, between 7 November 2013 and 17 January 2014, he dishonestly made retrospective alterations to Ameira’s clinical records and failed to keep clear, accurate and detailed clinical records.
From the outset Dr Davidson, who attended the hearing, did not admit the charges against him and denied that his conduct, if found proven, constituted serious professional misconduct.
A summary of the circumstances of the case were that the cat had been admitted to Dr Davidson’s practice on 8 November 2013 with poor appetite and a piece of thread in its mouth. The cat was later admitted, on 21 November, with dehydration and was diagnosed with a linear foreign body (ie the thread) on 25 November 2013. Dr Davidson continued to treat Ameira with corticosteroids and rehydration fluids at the practice but a second opinion was sought by Ameira’s owner from a nearby veterinary practice. This practice referred the cat to the Royal Veterinary College for treatment. Surgery to remove the linear foreign body was undertaken on 13 December 2013, albeit with a poor prognosis, and Ameira subsequently suffered two cardiac arrests and died on 14 December 2013.
In terms of its findings on the first charge, the Committee heard from an expert witness, Mr Hurst, regarding the use of the corticosteroids which were administered to the cat by Dr Davidson on 22, 27 and 30 November 2013 and 5 and 12 December 2013. Although Mr Hurst said that a minority of veterinary surgeons may have provided corticosteroids when the cat was first presented to Dr Davidson on 8 November; when it was determined by Dr Davidson’s colleague Mr Holden that the cat’s condition was due to it having ingested thread, the use of corticosteroids was inappropriate from then on and would be considered contra-indicated. The Committee found this charge proven.
The Committee did not find the charge against Dr Davidson that he failed to provide adequate fluid therapy proven. When the cat was presented to the practice on 21 November 2013 suffering from dehydration, fluid rehydration was given but not administered intravenously. The Committee concluded that intravenous hydration was not necessary because the clinical records from both Dr Davidson and the Royal Veterinary College indicated that Ameira was only moderately dehydrated.
Regarding the referral of Ameira, the Committee could not be sure that the cat was sufficiently unwell on 23 November that it required immediate referral. Dr Davidson had sent Ameira home with her owner on that date on the basis that she was stable and that he would arrange a referral for her on 25 November. There was conflicting evidence from Dr Davidson and Ameira’s owner on the matter of whether, on 23 November, Ameira’s owner was advised that the cat’s condition was critical or that a referral was urgently required. Dr Davidson accepted that he did not seek to make an urgent referral. The charge was not proven.
Regarding the communication of the urgency for further investigation of Ameira’s condition, the Committee found that there was insufficient evidence to suggest that Dr Davidson did not adequately communicate with Ameira’s owner after the diagnosis of a linear foreign body was made on 25 November. According to Dr Davidson, he explained the risk of further damage to the oesophageal and gastrointestinal tract and offered further radiography. This was strongly contested by Ameira’s owner. However, ultimately the Committee were unable to be satisfied as to which version was correct to the necessary standard of proof required.
Regarding the retrospective amendment of clinical records, the Committee found that although there were some “troubling aspects” about the case, particularly evidence of a telephone call with the RCVS Professional Conduct Department in which Dr Davidson said that no retrospective alterations had been made, it was unable to be satisfied so as to be sure of his motivation for changing the records. His contention was that changes had been made as he was concerned he would be subject to civil litigation by Ameira’s owner. However, the Committee found the charge not proven, also taking into account Dr Davidson’s good character and unblemished professional record over 40 years.
However, the Committee did find that Dr Davidson’s clinical records were illegible. Dr Davidson recognised the poor quality of his handwriting, which the veterinary surgeons to whom Ameira was referred were unable to understand. The Committee found this charge proven.
Taking into account the charges it found proven, the Committee then considered whether they constituted serious professional conduct either individually or cumulatively. Judith Webb, who chaired the Committee and spoke on its behalf, said: "It does not consider that on the facts of this case the administration of corticosteroids amounted to disgraceful misconduct."
She added: "The Committee has already emphasised the importance of making legible handwritten records but it does not consider that the failure to do so in this case amounts to disgraceful misconduct.... The Committee has found that Dr Davidson was wrong to make retrospective entries in this case without making it clear when such alterations were made. The Committee does not consider that in this case the making of those alterations was capable of being disgraceful misconduct. The case is dismissed."
The programme, which was developed in collaboration with the NHS Leadership Academy, is designed to teach a number of skills that underpin good leadership, including decision-making, resilience, implementing an inclusive culture and encouraging reflective learning approaches. It comprises two free-to-access courses and an optional paid for assessment.
The College says that one of the programme's most popular aspects is its audio drama, which follows the lives of veterinary professionals living in the fictional county of Glenvern. The stories that depict the characters’ working lives seek to reveal the diverse leadership challenges that veterinary professionals face on a day-to-day basis. This in turn prompts the listener to reflect, consider how they would respond, and learn from their own experiences as well as those of other people.
The first course was piloted this summer, with over 550 veterinary surgeons, veterinary nurses, students and practice managers helping the College to develop and refine the material, whilst a group of learners are currently piloting the second course in the series.
Simon Patchett MRCVS, who works at Vets Now 24/7 Emergency and Specialty Hospital, Glasgow, said: "This course really highlighted leadership qualities that are often taken for granted. The course demonstrates that you do not need a status position in order to demonstrate effective leadership even though status positions are often where we look for leadership. I would recommend this course to both vets and nurses in clinical practice - it's a real eye opener, and as a result of doing the course perhaps we can see less age-restricted approach to leadership within the veterinary profession?"
Given the overwhelmingly positive feedback received on the first course the RCVS has now opened the programme to all veterinary professionals.
The programme is now accepting registrations for a new cohort of learners to begin the first of three courses on 26th November. A ‘sign-up’ email will be sent out to all veterinary surgeons and veterinary nurses ahead of the course starting.
Director of Leadership and Innovation at the RCVS, Anthony Roberts, said: "I am very pleased to be able to announce the launch of this programme. I would urge anyone with an interest in developing their leadership skills, as well as those looking to refine their longstanding leadership skills, to take part. The feedback we have received on the first course in this programme [please see Notes to Editors] has shown us that this MOOC has a far-reaching application, and is both educational and enjoyable. Whether you are a vet, veterinary nurse, practice manager or student, this programme will be relevant and useful in your professional career."
For more information, visit: www.rcvs.org.uk/leadershipmooc or email: leadership@rcvs.org.uk
The programme, which will look at the achievements and contributions of people of African and Afro-Caribbean descent, will see Dr Greene being interviewed by presenter Alex Beresford alongside a number of other prominent black Britons including athlete and broadcaster Colin Jackson, publisher and author Margaret Busby, Mayor of Bristol Marvin Rees, and nurse and academic Dame Elizabeth Anionwu.
Mandisa said: “I am immensely honoured to be the first Black President of the RCVS and to use this opportunity to speak to the black community, and indeed all communities, about my love of veterinary science and the importance of the work we do in safeguarding animal health and welfare and wider public health.
"I am a great believer in the phrase ‘if you see it, you can be it’ and I hope that my various talks this month and, particularly the upcoming ITV documentary, will help people recognise that veterinary professionals can come from a diverse range of backgrounds and that, provided they have the drive and the ambition, there should be no barriers to them meeting their dreams."
A petition to protect the title Veterinary Nurse has received an impressive 1,285 signatures, including many from veterinary surgeons, and an official response from HM Government.
The petition, which was started by VetNurse.co.uk member Nick Shackleton Dip AVN (Surgical) VN on 6th June last year, explained: "The title veterinary nurse at present is not a protected title. A lot of people who work in practice call them selves veterinary nurses, when they have no theoretical training in such a position. As qualified nurses we feel that this issue should be addressed so that the general public are no longer confused as to the qualification and hopefully make them more aware of the hard work it is to gain the qualification. As we are heading for autonomy within the profession I think it is right and fitting that the title should be protected."
The Government response, whilst predictably noncommittal, did at least seem to recognise the issue: "The Royal College of Veterinary Surgeons (RCVS) maintains the Statutory List of veterinary nurses. In order to qualify, nurses must undergo a two-year period of vocational training which is assessed at work and through examination by the RCVS Awarding Body.
On being added to the Statutory List they are entitled to undertake a range of veterinary treatments and procedures on animals under veterinary direction. Only listed nurses are entitled to use the post-nominal letters 'VN'. The RCVS are introducing new arrangements for 'registered' veterinary nurses which provides greater accountability and transparency for those nurses whose names are entered on the register. These arrangements run in parallel with the Statutory List.
Some veterinary practices may employ staff who do not carry out the duties of a veterinary nurse but possibly use that title or wear a uniform which might imply that they are a trained veterinary nurse. We appreciate that there are issues surrounding best practice that the RCVS and the Veterinary Nursing Council to address.
It is generally accepted that the arrangements for regulating veterinary nursing could be modernised. This would, in due course, help provide greater protection for the title of veterinary nurses. Although Defra currently has no plans to undertake a fundamental review of the Veterinary Surgeons Act, we are regularly in touch with the RCVS to better understand its priorities for regulatory reform.
In his talk, 'Digital Veterinary Practice', Adam presents an exciting and compelling vision as to how technology will transform the profession and enable veterinary surgeons to offer better care to more patients.
His talk begins with an interesting look at how technological change has gathered pace in recent years, before considering some of the emerging technologies that could be applied to veterinary practice.
In particular, he talked about the so-called 'Internet of things': the way more and more 'things' other than computers are connected to the Internet.
There are now about 9bn 'things' connected to the internet, by 2020 there are expected to be 50bn. Adam predicted that more and more of them are going to be worn by animals: to measure reproductive health in farm animals; to track performance in equines; and to monitor behaviour and activity in companion animals.
Adam discussed how there is already a smart litter box which measures an animal’s habits, an oral pill camera that can take 360 degree internal photos, 3D printed drugs and digitised microscopy. By uniting these technologies with increasingly accurate virtual reality technology, he said, long-distance examinations could become a real possibility.
In relation to the role of the RCVS, Adam explored how the profession could be proactive in engaging with these technologies, such as by: using regulation as a mechanism to attract 'disruptors' to work alongside the profession; identifying areas of retraining and creating targeted learning opportunities; fostering an entrepreneurial mindset; creating an early-adopter network of practices to foster initial collaboration; and framing industry challenges as targeted problems whose solutions can be crowd-sourced.
Earlier this year, the RCVS Council approved the roll-out of a more outcomes-based model of CPD to encourage veterinary professionals to engage in greater reflection on learning and development, and the impact that it has on their professional practice.
To support this approach, Council also approved the development of a new CPD recording platform designed to be more intuitive and to make it easy to record CPD in real time.
The College says the new platform – which has the working title of 'One CPD' – will be a ‘one stop shop’ CPD management solution for veterinary surgeons and nurses at all stages of their careers, including veterinary students and student veterinary nurses.
Richard Burley, RCVS Chief Technology Officer, said: "We’re excited to open up access to this powerful, next-generation, tool we’ve been building and welcome our members into an important phase of the development process. Testing with our members will be absolutely critical in delivering the very best experience possible for all those that use 'One CPD' in the future. Ease of use and truly valuable functionality are key deliverables for us and both these need the feedback of our members to perfect."
Dr Linda Prescott-Clements, RCVS Director of Education (pictured right), added: "The first stage of the development of the CPD recording platform is due to finish in October and so we are looking for a cohort of both veterinary surgeons and nurses who can spend a few months this autumn using the new platform to record and reflect on their CPD, in order to test out some of the new features which aim to make this process so much easier to do. We will consider their feedback carefully in order to improve the recording platform ready for launch in January 2020.
"The new ‘One CPD’ platform will ultimately replace the current Professional Development Record, and its use will become mandatory for recording CPD from January 2022.
"In addition to setting up the testing group, we are also looking to meet with key CPD providers for veterinary surgeons and veterinary nurses over the coming months to discuss our plans for outcomes-based CPD and the development of the recording platform in greater detail."
Veterinary surgeons who'd like to take part in the testing for the CPD app, as well as CPD providers who want to discuss the College’s CPD policy plans, should contact Jenny Soreskog-Turp, RCVS CPD Officer, on cpd@rcvs.org.uk or 020 7202 0701.
The Disciplinary Committee considered a number of charges against Javier Salas Navarro MRCVS and Roman Kristin over 35 days.
The charges against Dr Navarro concerned his treatment of a kitten named Marnie. They included:
In August 2016, failing to read the anaesthesia consent form in relation to a surgical spay he performed;
When Marnie was readmitted for surgery, failing to read the anaesthesia consent form, failing to undertake adequate assessment of Marnie’s condition; performing surgery without adequately considering her condition; subjecting Marnie to anaesthesia without recognising the seriousness of her illness; failing to obtain informed consent from the owners; administering medication which was contra-indicated; and failure to make an adequate record of his involvement in Marnie’s care.
The charges against Dr Kristin also related to his treatment of Marnie. They included:
In August 2016, failing to undertake an adequate assessment of her condition; failure to recognise and record the fact that Marnie could not pass urine; failure to refer or offer her for specialist treatment; and failure to ensure Marnie received care and treatment overnight.
When admitting Marnie for surgery, that he made a number of clinical mistakes including failure to gain informed consent; and failure to recognise the seriousness of her illness;
that there were a number of failings in relation to Marnie’s care, including failure to arrange adequate overnight care, failure to monitor and record her condition, and failure to gain informed consent for the overnight care.
that he failed to advise Marnie’s owners that he suspected her uterers had been ligated during the spay, failed to advise Marnie’s owners that she required specialist veterinary treatment; and advised that Marnie undergo further surgery at the practice in spite of this meaning her having to undergo further anaesthesia in a week and with poor chances of survival;
that the above conduct was misleading and dishonest.
The Disciplinary Committee found a number of the facts in the charges against both Dr Navarro and Dr Kristin proven (the full details can be found in the documentation at www.rcvs.org.uk/disciplinary).
The Committee found that Dr Navarro breached a number of aspects of the Code of Professional Conduct for Veterinary Surgeons including: making animal health and welfare the first consideration when attending to animals; the provision of appropriate and adequate veterinary care; responsible prescription, supply and administration of medicines; communication with professional colleagues to ensure the health and welfare of the animal; being open and honest with clients and respecting their needs and requirements; effective communication with clients; keeping clear and accurate clinical records; and working with the veterinary team to coordinate the care of animals.
Of the proven charges, the Committee found that his initial failure to read Marnie’s anaesthesia consent form on 5 August did not amount to disgraceful conduct in a professional respect, but that the repetition of this failure on 9 August did amount to disgraceful conduct. It also found that Dr Navarro’s failure to undertake adequate assessment and perform surgery without this assessment amounted to serious professional misconduct. Furthermore, the Committee found that subjecting Marnie to anaesthesia in spite of her being unwell, failure to obtain informed consent and failure to keep adequate records also amounted to serious professional misconduct.
For Dr Kristin, in summary, the Committee found not proven the allegation that he had failed to respond on 5 August 2016 to concerns from Marnie’s owners about her condition while she was recovering from a surgical spay and also all the allegations relating to Dr Kristin’s admission of Marnie to the practice on 9 August on the basis that it was not satisfied so as to be sure that Dr Kristin had been the veterinary surgeon who admitted Marnie on that day.
The Committee found proven the remaining charges and found he breached the following parts of the Code of Professional Conduct for Veterinary Surgeons: making animal health and welfare the first consideration when attending to animals; keeping within area of competence and referring responsibly; providing appropriate and adequate veterinary care; responsible prescribing, supply and administration of medicines; communication with colleagues to ensure the health and welfare of the animal; being open and honest with clients and respecting their needs and requirements; communicating effectively with clients and obtaining informed consent; keeping clear and accurate clinical records; and working with the veterinary team to coordinate the care of animals.
Of the proven charges, the Committee determined that his failure to adequately assess Marnie’s health, to obtain a clinical history, to undertake blood tests and recognise that she was seriously ill, amounted to disgraceful conduct in a professional respect and led to “Marnie’s underlying condition going undetected and undoubtedly contributed to her eventual death two days later”.
The Committee also found that Dr Kristin’s decision to hospitalise Marnie without adequate overnight care, place her on IV fluids without monitoring the treatment or her condition, and failure to obtain adequate informed consent – among other things – amounted disgraceful conduct in a professional respect.
Stuart Drummond, chairing the Committee and speaking on its behalf, said: "As a direct result of Dr Kristin’s acts and omissions, Marnie was left alone overnight on fluids when those fluids had nowhere to go. Had he done his job properly he would have known that and Marnie could have avoided the prolonged suffering caused by the chosen course of treatment that did not address the underlying condition. Every element of Dr Kristin’s behaviour was catastrophic for Marnie, and yet he took no personal responsibility for her welfare and just went home.”
Following its findings on disgraceful conduct in a professional respect, the Committee then went on to consider its sanction for both Dr Navarro and Dr Kristin.
In respect of Dr Navarro, the Committee considered the mitigating factors including previous good character, admissions to some of the facts of the case from the outset; genuine insight and remorse into the seriousness of the actions; his youth and inexperience; and relevant and good-quality testimonials from colleagues. The Committee noted that the testimonials were universally positive and demonstrated that Dr Navarro had reflected on his conduct, had become more mature and confident in his practice and made efforts to rectify the areas in which he had fallen below standards.
Stuart Drummond said: “Although the consequences for Marnie and her owners were clearly devastating, the Committee considered that Dr Navarro’s part in her demise has to be seen in the context of all the evidence. In light of the extensive mitigation, including significant evidence of insight and remediation, the Committee was able to conclude that Dr Navarro did not represent a future risk to animals or the public. In such circumstances, the Committee considered that it was not necessary to restrict Dr Navarro’s registration and that a reprimand was the appropriate and proportionate sanction in his case.”
In relation to Dr Kristin, the Committee took into account positive character evidence from Mr Karel Daniel, a semi-retired veterinary surgeon and Vice-President of the Czech Republic Veterinary Chamber, a similar body to the RCVS in that country, as well as other testimonials on his behalf. In mitigation, the Committee considered Dr Kristin’s previously unblemished career, the fact that it was a single case involving a single animal; some development of insight into his conduct; no evidence of repetition; expressions of remorse; the impact of a family bereavement during the course of proceedings; and his financial position.
However, the Committee also took into account aggravating factors including a lack of candour from Dr Kristin when he was giving evidence, demonstrated by a tendency to blame others rather than take responsibility, as well as his recklessness in suggesting a third operation on Marnie that was not in her interests, rather than referring her into specialist care.
The final decision of the Committee on the sanction for Dr Kristin was that, given the seriousness of the misconduct, it was satisfied that this warranted a six-month suspension period. However, given the mitigating factors, the Committee decided that four months was appropriate and proportionate.
Commenting on the sanction Stuart Drummond said: “The Committee determined that it was important a clear message be sent that this sort of behaviour is wholly inappropriate and not to be tolerated. It brings discredit upon the respondent and discredit upon the profession and, most importantly, caused harm to Marnie and great distress to her owners.
"The Committee did consider whether to remove Dr Kristin from the Register. However, in light of the mitigation in this case, the fact that this was a single case in an otherwise unblemished career, together with the unlikelihood he would repeat his disgraceful conduct, the Committee decided that, in all the circumstances, to remove him from the Register would be disproportionate.
"The Committee therefore decided to order that the Registrar suspend Dr Kristin’s registration…. The Committee was satisfied that a period of four months was appropriate and proportionate in all the circumstances."
The full facts and findings from the case can be found at www.rcvs.org.uk/disciplinary